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Traditionally, catheter-based percutaneous cecostomy has been utilized in the setting of closed-looped colonic obstruction and in selected patients with fecal incontinence in whom conservative management has failed. Although the procedure is associated with high rates of technical success, complications including catheter migration or dislodgement are common and occur in up to a third of patients. Catheter occlusion and leakage from the catheter site are also common, with leakage often occurring on the skin (20%) or within the peritoneum (12%) [1–5]. Here, we explored the option of using a percutaneous, fully covered, self-expandable, metal stent (FCSEMS) for sequential decompression following malfunction of a percutaneous catheter. In theory, the caliber of the stent would allow improved drainage, while the external flange could be secured with a suture, reducing the risk of migration or dislodgement. A 44-year-old man with a complex medical history, including heart and kidney transplants and recurrent urothelial cancer, presented with colonic obstruction, secondary to metastasis from the latter, at the level of the ascending colon (▶Fig. 1 a). On computed tomography (CT), the cecum was dilated with solid fecal matter and demonstrated pneumatosis intestinalis of the cecal wall (▶Fig. 1b, c). As the patient was a poor surgical candidate, traditional colonic stenting was considered; however, this was deemed unsuitable in view of the high risk of cecal perforation secondary to gas insufflation. Therefore, we opted for placement of a CT-guided percutaneous cecostomy tube as a temporizing measure (▶Fig. 1 d). While technically successful, the percutaneous cecostomy tube failed to provide significant decompression and the patient experienced both leakage onto the skin and occlusion of the catheter. Thus, we subsequently exchanged the catheter E-Videos

Percutaneous cecostomy with fully covered self-expandable metal stent for initial management of severe malignant colon obstruction