Percutaneous Endoscopic Colostomy for Morbid Obesity with Chronic Intestinal Pseudo-Obstruction: Technical Challenges and Long-Term Outcomes

Abstract Chronic intestinal pseudo-obstruction (CIPO) is a rare motility disorder, with recurrent sigmoid volvulus as a possible life-threatening complication. Surgical resection is curative; however, this is rarely possible in high-risk patients. A 68-year-old man, with a body mass index (BMI) of 52 kg/m² and multiple comorbidities, presented with recurrent sigmoid volvulus on a CIPO background. He had multiple colonoscopic decompressions, which only provided temporary relief. Given the high anesthetic risk, a percutaneous endoscopic colostomy (PEC) was performed under propofol sedation and a transversus abdominis plane block. Technical challenges included a thick abdominal wall, leading to poor endoscopic transillumination. This was overcome using a combination of transillumination, finger indentation, and the dark-room technique. Two 24 Fr PEC tubes were placed 4 cm apart in the right lumbar region, achieving immediate decompression. The post-procedural course was uneventful, with complete symptom resolution and no recurrence at 18-month follow-up. In morbidly obese patients with CIPO and recurrent volvulus, PEC can be performed safely with appropriate technical modifications. This case is the first highlighting weight and obesity and contributes to the PEC literature, while reaffirming PEC’s role as a minimally invasive procedure for patients who are surgically unfit.