S3895 Anchoring Relief: Endoscopic Fixation of Rectal Tube for Bowel Decompression in Ogilvie’s Syndrome

Introduction: Ogilvie’s syndrome or acute colonic pseudo-obstruction (ACPO) is characterized by marked colonic dilatation in the absence of a mechanical cause. Initial management typically includes supportive measures, neostigmine and colonoscopic decompression. In refractory cases, placement of a rectal tube for colonic decompression is often employed. However, tube dislodgement is a frequent limitation, compromising clinical efficacy. We describe a novel technique of endoscopic rectal tube fixation using endoclips at multiple colonic sites to enhance retention and therapeutic outcomes. Case Description/Methods: An 80-year-old man was admitted to the Intensive Care Unit with acute metabolic encephalopathy, sepsis and ileus. Supportive management including correction of electrolytes, early ambulation and avoidance of opioids and anticholinergics had insufficient improvement. Pharmacologic intervention with 2 mg intravenous neostigmine produced minimal response. A decision was made to proceed with colonoscopic decompression and rectal tube placement. A pediatric colonoscope was introduced via the rectum and carefully advanced to the cecum and decompressed first. The scope was withdrawn, and a Cook rectal tube with multiple side holes was selected, 3 thread loops were prepared; 1 at the tip, the second approximately 12 inches proximal and the third, 24 inches proximal from the tip. The colonoscope was reinserted while grasping the most distal loop with biopsy forceps. Upon reaching cecum, the loop was released, and 2 endoclips were deployed to anchor the loop to the cecal mucosa. The same technique was used to anchor the second loop to the transverse and the third loop to the descending colon. This provided fixation of the rectal tube at 3 key anatomical locations. The rectal tube was connected to a ureteric drainage bag. The tube remained in situ for 4 days, confirmed on imaging. The patient showed continuous clinical improvement. The tube eventually passed spontaneously per rectum on day 5. Discussion: Rectal tube dislodgement is a well-recognized challenge during management of ACPO. Our technique of securing the rectal tube with endoclips at the cecum, transverse and the descending colon provided enhanced stability and prolonged therapeutic decompression. This technique may minimize the risk of rectal tube dislodgement, reduce the need for repeated procedures or surgery and may serve as a valuable tool in the management of refractory ACPO. Larger cohort studies are needed to validate our approach.