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Percutaneous endoscopic colostomy (PEC) is a minimally invasive alternative to surgery for treating severe chronic constipation and refractory anorectal disorders. Based on the concept of Malone appendicostomy, PEC enables antegrade colonic irrigation through a catheter inserted into the cecum under endoscopic guidance. This procedure facilitates bowel emptying and improves quality of life. It is primarily indicated for severe chronic constipation that does not respond to medical treatment, anorectal dysfunction of neurological origin, recurrent colonic pseudo-obstruction (Ogilvie syndrome), and passive fecal incontinence. This procedure is only recommended after a complete morphological and functional evaluation and after conservative treatment has failed for at least six months. The procedure is performed under general anesthesia and consists of cecopexy with placement of a Chait Trapdoor™ catheter. Complications most often occur at the incision site (chronic pain, granulomas, oozing, and superficial infections) and affect about half of patients, while intra-abdominal complications remain rare. Recent studies show a clinical success rate of 60 to 70%, with significant improvements in constipation (KESS), fecal incontinence (Cleveland), and quality of life (GIQLI) scores. However, approximately one third of patients have the device removed within the first year, primarily due to chronic pain at the insertion site. In conclusion, PEC is a more effective and less morbid option than colonic surgery. It offers functional improvement and enhanced quality of life in selected cases of refractory constipation or incontinence, while delaying or avoiding the need for more invasive surgical procedures.