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Percutaneous Cecostomy Insertion - Variations - |
| Occasionally air introduced into the rectum does not fill the cecum. Placing the patient in the left side down or lateral decubitus position usually allows good filling of the cecum. Rotation of the C-arm may be necessary to separate loops of bowel that overlie the cecum. We have had one patient whose procedure was delayed because of very distended sigmoid overlying the cecum. The procedure was repeated and the cecum was clearly separated from the sigmoid and a successful procedure performed. VP shunts are avoided if possible, although evidence indicates that the procedure is safe even in this patient group. Occasionally the cecum is high and just below the ribs and a more lateral and superior approach is used. It is important to examine the borders of the liver, spleen and gallbladder with ultrasound in case this situation is found. If the retention sutures break during the procedure, we replace the suture prior to further dilatation. Safe access obstructed by dilated loops of bowel may be improved by percutaneous needle decompression. |
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