EURORAD ESR

Case 1815

Percutaneous cecostomy decompression

Author(s)
Marcy P-Y, Bailet C, Chemaly L, Gallard J-C, François E
 
Patient
male, 74 year(s)
 
 
  • Figure 1
    Non obstructive colonic dilatation
     

    The AP scout-view shows non obstructive colonic dilatation (confirmed by endoscopy) with predominant cecal dilatation.

     
    Area of Interest: unknown; Imaging Technique: Non obstructive colonic dilatation;

    The CT- scan shows an axial diameter of 140mm of the cecum, mild dilatation of the transverse colon, and absence of pneumoperitoneum or collection.

     
    Area of Interest: unknown; Imaging Technique: Non obstructive colonic dilatation;

    CT- scan allows skin marking of the optimal site of drainage via the anterior transperitoneal approach. The colonoscopy is performed prior to PCC in order to exclude a potential perforating wall lesions.

     
    Area of Interest: unknown; Imaging Technique: Non obstructive colonic dilatation;
     
     
  • Figure 2
    Percutaneous Ceco Pexy: technical aspects
     

    18G- needle puncture of the distended cecum. Magnified view: Contrast medium cecal opacification is performed before pushing the first T- fastener through the 18G needle into the lumen. Placement of nylon T- fasteners...

     
    Area of Interest: unknown; Imaging Technique: Percutaneous Ceco Pexy: technical aspects;

    Third T- Fastener placement. Two T- shaped single pieces of stainless steel have already attached the colon to the abdominal wall.

     
    Area of Interest: unknown; Imaging Technique: Percutaneous Ceco Pexy: technical aspects;

    Over the wire 17F- peel away introducer sheath placement.

     
    Area of Interest: unknown; Imaging Technique: Percutaneous Ceco Pexy: technical aspects;
     
     
  • Figure 3
    Corresponding Schemes


    [a]T- Fastener placement into the cecal lumen: needle puncture, the T- shaped single piece is pushed through the needle and will affix the cecum to the abdominal wall.
    [b) Over- the wire- Peel away sheath...

     
    Area of Interest: unknown; Imaging Technique: Corresponding Schemes;
     
     
  • Figure 4
    AP abdominal plain film control, after 48 hours

    Contrast medium opacification of the 17F- catheter shows complete regression of the colonic distension, after 48 hours. The T- fasteners are removed within 10 days. The aspiration 17F- catheter (arrow head) is left...

     
    Area of Interest: unknown; Imaging Technique: AP abdominal plain film control, after 48 hours;
     
     
The AP scout-view shows non obstructive colonic dilatation (confirmed by endoscopy) with predominant cecal dilatation.
 
The CT- scan shows an axial diameter of 140mm of the cecum, mild dilatation of the transverse colon, and absence of pneumoperitoneum or collection.
 
CT- scan allows skin marking of the optimal site of drainage via the anterior transperitoneal approach. The colonoscopy is performed prior to PCC in order to exclude a potential perforating wall lesions.
 
18G- needle puncture of the distended cecum. Magnified view: Contrast medium cecal opacification is performed before pushing the first T- fastener through the 18G needle into the lumen. Placement of nylon T- fasteners reduces the potential for peritoneal spillage : they are used to affix the cecum to the anterior abdominal wall. They allow the insertion of large catheters.
 
Third T- Fastener placement. Two T- shaped single pieces of stainless steel have already attached the colon to the abdominal wall.
 
Over the wire 17F- peel away introducer sheath placement.
 

[a]T- Fastener placement into the cecal lumen: needle puncture, the T- shaped single piece is pushed through the needle and will affix the cecum to the abdominal wall.
[b) Over- the wire- Peel away sheath placement
[c] Over- the wire- 17F- Decompression Catheter placement; the guide wire is retrieved.
 
Contrast medium opacification of the 17F- catheter shows complete regression of the colonic distension, after 48 hours. The T- fasteners are removed within 10 days. The aspiration 17F- catheter (arrow head) is left in place.
 
 
 
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