Experience with 40 cases of congenital pouch colon

Abstract

ABSTRACT ABSTRACT ABSTRACTAim: The aim of this study was to analyze the clinical and management aspect of congenital pouch colon. Materials and Methods: This retrospective study was carried out on 40 cases of congenital pouch colon managed in the department of paediatric surgery from 01, January 2000 to 31, December 2005. Results: The incidence of congenital pouch colon (CPC) in the present study was 11.29% (40 of 354) of all anorectal malformations (ARM) and 19.60% (40 of 204) of high ARM. Of these 40 cases of CPC included in the study, 82.5% were male and 17.5% were female. The average age of presentation to hospital was 3.36 days with a range of 1-11 days; of these 25% patients were admitted with poor general condition. Preoperative diagnosis of CPC was possible in 75% of cases in our study. 60% (n=24) of cases had incomplete pouch colon (Type III and IV) while 40% (n=16) had complete pouch colon (Type I and II). Right transverse colostomy was done in 16 patients and colostomy at descending colon just proximal to pouch in two patients for incomplete (Type III and IV) CPC as a primary initial procedure. Ileostomy was done in 14 patients and window colostomy in three patients for complete (Type I and II) CPC. As definitive procedures, pouch excision and abdomino-perineal pull-through of colon was done in 17 patients, coloplasty and abdomino-perineal pull-through of coloplasty colon was done in four patients and pouch excision and abdomino-perineal pull-through of terminal ileum in four patients in our series. None of our patients underwent primary single stage procedure. Conclusion: (1) CPC comprises 11.29% of all ARM and 19.60% of high ARM. (2) Right transverse colostomy was opted for incomplete pouch colon, while Ileostomy and window colostomy were opted for complete pouch colon as initial surgical procedures. (3) Staged surgical procedures for management of CPC were well tolerated in our KEY WORDS: Anorectal malformation, congenital pouch colon, congenital short colon, staged surgical procedures reported to occur from 2 to 15.1%. [3][4][5] Almost all the series reported male preponderance. We are reporting our Congenital pouch colon (CPC) is defined as a condition experience with management of 40 cases of CPC with a in which whole or part of the colon is replaced by a brief review of literature.series.

The anomalous clinical anatomy of congenital pouch colon in girls

“…As in boys, and similar to our findings, the CPC subtypes I and II appear to be more common than the subtypes III and IV [2][3][4][5][6]13]. In most cases, the colonic pouch has been reported to terminate in a fistulous communication with either the vagina or a persistent cloaca [1][2][3][4][5][6]8,9,[11][12][13][14][15][16][17][18][19]. In other reports, the colonic pouch has been described as ending in a vestibular fistula [2,6,9,10,12,16,18,20], a colovesical fistula [2,6,7,9,10,13,14,21], or, as in one case, a perineal fistula [22].…”

“…In most cases, the colonic pouch has been reported to terminate in a fistulous communication with either the vagina or a persistent cloaca [1][2][3][4][5][6]8,9,[11][12][13][14][15][16][17][18][19]. In other reports, the colonic pouch has been described as ending in a vestibular fistula [2,6,9,10,12,16,18,20], a colovesical fistula [2,6,7,9,10,13,14,21], or, as in one case, a perineal fistula [22]. Mathur et al [9] reported that 16 of 27 girls with CPC had a colouterine fistula.…”

“…However, in female patients, the anatomy of the anomaly is more variable, perhaps because of the additional role played by the Müllerian duct system in the development of the internal genital organs, lower urinary tract, and the external genitalia [10]. In addition, a large number of girls with CPC may present for the first time during infancy or childhood if evacuation through the terminal fistula of the colonic pouch is effective [2,[4][5][6][11][12][13].…”

Congenital pouch colon syndrome in a Saudi Arabian neonate

“…Management depends on the length of colon available. Our case is an incomplete type of CPC where enough normal colon is available, so urinary fistula was divided and the pouch was resected [7,9]. The residual normal colon was brought to the perineum by an abdominoperineal pull-through operation.…”

The colovesical fistula in congenital pouch colon: a histologic study

“…Although some histopathologic studies of the colonic pouch in patients of CPC have been reported [2,3,[7][8][9], there is only one report of histologic examination of the terminal CVF in patients with CPC [10]. In this article, we report the results of histopathologic examination of the CVF excised during surgical management of male patients with type I/II CPC.…”