Percutaneous endoscopic cecostomy (PEC) is an uncommonly used rescue approach for refractory constipation and/or pseudoobstruction. Next, the center of sutures arranged in a triangular fashion was punctured with a large trocar with a peel-away sheath (Fig. b), through which a balloon tube was inserted and adequately blocked (Fig. c). Therefore, another uncomplicated lower endoscopy was performed, and a well-matured PEC tract could be confirmed in a through-the-balloon view (Fig. d).