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Duci M, Fascetti-Leon F, Pergola EL, Midrio P, Gamba P. Congenital Pouch Colon: Case Series and Review of Evidences for Resection. J Indian Assoc Pediatr Surg 2021; 26:153-161. [PMID: 34321786 PMCID: PMC8286030 DOI: 10.4103/jiaps.jiaps_53_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/24/2020] [Accepted: 09/20/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Congenital pouch colon (CPC) is a rare variant of anorectal malformations (ARM) with its highest reported incidence in India. We aimed to describe five patients affected by CPC, in which the tissue from the terminal dilated colon has been successfully used and to discuss our results on the light of an extended revision of the literature. Materials and Methods: The clinical details of five cases treated for CPC in two Italian Centers were retrospectively reviewed assessing the fate of the terminal dilated colon. Results: In all cases, the tissue from dilated colon has been used. The double vascular system of the dilated pouch allowed increasing bladder capacity (case 4), reconstruction of the vagina (case 3, 5), and lengthening of the colon (case 1, 2, 5).In our series, 3/5 have a good bowel control with daily bowel management after ARM correction. In literature, there are not differences in terms of dependence from bowel management in patients with pouch resected and in patients with pouch saved (P = 0.16). Conclusions: We acknowledge that the analysis of the available literature is limited by the absence of studies with high level of evidence and the removal or the preservation of the abnormal colon tissue seems to follow the surgeon preferences.
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Affiliation(s)
- Miriam Duci
- Department of Salute della Donna e del Bambino, Division of Pediatric Surgery, University of Padova, Padova, Italy
| | - Francesco Fascetti-Leon
- Department of Salute della Donna e del Bambino, Division of Pediatric Surgery, University of Padova, Padova, Italy
| | - Enrico La Pergola
- Department of Pediatric Surgery, Vittore Buzzi Children Hospital, Milano, Lombardia, Italy
| | - Paola Midrio
- Mother and Child Department, Pediatric Surgery Unit, " Cà Foncello Hospital" Treviso, Treviso, Italy
| | - Piergiorgio Gamba
- Department of Salute della Donna e del Bambino, Division of Pediatric Surgery, University of Padova, Padova, Italy
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Narbaev TT, Aliev MM, Yuldashev AY, Turaeva ZT. [Morphological criteria for surgical treatment of anorectal malformations in children]. Khirurgiia (Mosk) 2021:48-52. [PMID: 33570354 DOI: 10.17116/hirurgia202102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To improve treatment outcomes in patients with anorectal malformations via research of morphological criteria and differentiated approach to surgical correction. MATERIAL AND METHODS There were 37 children with various types of anorectal malformations for the period 2000-2019. We analyzed morphological features of atretic rectum wall, fistula, anastomosis with adjacent organs and skin of the perineum. RESULTS Morphological research of anorectal malformations made it possible to differentiate treatment strategy and explain the causes of unsatisfactory results after perineal and abdominal-perineal proctoplasty. Incidence and severity of complications, as well as early disability were reduced that significantly improved postoperative quality of life. CONCLUSION According to the morphological criteria, deeper mobilization of atretic rectum within at least 2.5-3 cm of the rectal «cone» with intact muscular wall is necessary. This approach was valuable to ensure adequate closure function of the rectum, prevent anal incontinence and restore normal appearance of the perineum. These achievements contributed to decrease in the incidence of admissions, redo surgeries and improvement of social adaptation in children.
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Affiliation(s)
- T T Narbaev
- Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
| | - M M Aliev
- Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
| | - A Yu Yuldashev
- Tashkent State Stomatology Institute, Tashkent, Uzbekistan
| | - Zh T Turaeva
- Tashkent Pediatric Medical Institute, Tashkent, Uzbekistan
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Qadir QMS, Mohammed AA. Congenital pouch colon in Duhok, outcome and complications: Case series. Ann Med Surg (Lond) 2019; 45:86-90. [PMID: 31417674 PMCID: PMC6690573 DOI: 10.1016/j.amsu.2019.07.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 11/30/2022] Open
Abstract
Background Congenital pouch colon (CPC) is a rare congenital abnormality associated with anorectal malformations with high incidence of complications and mortality. The aim of this study is to describe the various types of congenital colon pouch, their management aspects, complications of surgery, and the best management options. Results The incidence of congenital pouch colon in the present study was 5.3% (18 patients) of all anorectal malformations. Sixteen cases (88.8%) were males and 2 cases (12.5%) were females, (M: F ratio was 8:1). The age of presentation was ranged from 1day to 1year; 17 cases were presented in first week of life. Preoperative diagnosis of congenital pouch colon was done in 7 patients. As an initial procedure tabularization of the pouch with end colostomy was done in 15 cases, window colostomy was done in 2 cases, and excision of the pouch and proximal ileostomy was done in one patient. As a definitive procedure, abdomino-perineal pull-through of the tabularized pouch was done in 15 cases, ileo-anal anastomosis after pouch excision was done in 3 cases. Conclusions Pouch tabularization and end colostomy had better outcome than other types of interventions. Abdomino-perineal pull through of the tabularized pouch was the definitive surgical procedure for treatment of complete pouch colon in our study. Congenital pouch colon is a rare disease that requires early diagnosis and treatment. Window colostomy at the pouch is better to be avoided due to high incidence of complications. Pouch tabularization and end colostomy has better outcome than other types of interventions.
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Affiliation(s)
- Qadir Mohammed Salih Qadir
- Pediatric Surgeon, University of Duhok, College of Medicine, Duhok Pediatric Surgery Center, Duhok City, Kurdistan Region, Iraq
| | - Ayad Ahmad Mohammed
- General Surgeon, University of Duhok, College of Medicine, Department of Surgery, Azadi Teaching Hospital, 8 Nakhoshkhana Road, 1014 AM, Duhok City, Kurdistan Region, Iraq
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Singh S, Rawat JD, Kumar P. Congenital pouch colon: Our experience with coloplasty. Afr J Paediatr Surg 2018; 15:16-21. [PMID: 30829303 PMCID: PMC6419546 DOI: 10.4103/ajps.ajps_88_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Congenital pouch colon (CPC) or congenital short colon is an entity found mainly in Indian subcontinent. In CPC, colon is replaced with partially or completely abnormal pouch connected to the genitourinary tract by a fistula (colovesical). Management protocol is different in different institute. In this article, we are sharing our three stage standard management approach; principle and technique of coloplasty in cases in which colon length is not adequate for pull through and their follow-up. This study aims to show the result of coloplasty in complete CPC. MATERIALS AND METHODS This is retrospective observational study, of 5 years duration. The medical record of these patients was reviewed for demographic information, clinical features, investigations performed, operative notes, post-operative events and the outcome of surgery. RESULTS Total of 626 ARM cases were managed in 5 years duration in which 64 were of pouch colon. The age of presentation was 1-15 days. In fifty patients who completed their, all stage in that 34 patients were in which coloplasty were done in rest of 16 cases excision of CPC and colonic pull through done in view of adequate colonic length (type III and IV) for pull through. In 34 patient in which coloplasty were done showed satisfactory cosmetic and functional out came after stoma closer in follow-up. CONCLUSIONS Properly created coloplasty and three stage procedure for complete pouch colon give better result and less complications. Excision of pouch is not requiring in all cases of CPC.
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Affiliation(s)
- Sudhir Singh
- Department of Paediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - J D Rawat
- Department of Paediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Piyush Kumar
- Department of Paediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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Shinde NK, Kumar P, Dabla PK, Jhanwar P, Chadha R, Choudhury SR. Assessment of Nutritional Status of Patients of Congenital Pouch Colon Following Definitive Surgery. J Indian Assoc Pediatr Surg 2017; 22:13-18. [PMID: 28082770 PMCID: PMC5217132 DOI: 10.4103/0971-9261.194613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose: To assess the nutritional status in 31 patients of congenital pouch colon (CPC) who had undergone definitive surgery and closure of a protective stoma, if any, at least 1 year earlier and were below 14 years age. Materials and Methods: The clinical history, demographic details, anthropometric measurements, and results of hematological and biochemical tests were recorded. In addition to collective data, analysis was also performed after grouping by age, subtype of CPC (Types I/II and Types III/IV CPC), and in Types I/II CPC patients, by whether the colonic pouch had been completely excised or else a segment preserved by tubular colorraphy (TC). Results: Severe fecal incontinence (FI) was common (64.52%). Anthropometry showed a significant malnutrition in 53.85–95.45% patients, especially stunting which was most prevalent in the 0–5 years age-group. Serum Vitamin B12, folate, and Vitamin D were lower than normal in 38.71%, 22.58%, and 74.19% patients, respectively, without statistically significant difference among the various groups studied. Patients with Types I/II CPC had a statistically significant higher incidence of anemia, low serum ferritin, and severe FI than patients with Types III/IV CPC. Patients with Types I/II CPC, managed by excision of the colonic pouch, had a higher incidence of severe FI, wasting, and thinness than those undergoing TC. Conclusions: On follow-up of the patients of CPC, anthropometry shows a high incidence of malnutrition, especially stunting in the 0–5 years age-group. There is an adequate adaptation of fluid-electrolyte homeostasis. Although Types I/II CPC patients have a significantly higher incidence of anemia and severe FI than Types III/IV CPC patients, long-term anthropometric parameters are similar. In Types I/II CPC, preservation of the colonic pouch by TC offers long-term benefit.
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Affiliation(s)
- Nand Kishor Shinde
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Praveen Kumar
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | | | - Praveen Jhanwar
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - Subhasis Roy Choudhury
- Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
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Abstract
Congenital pouch colon (CPC) is an unusual abnormality in which a pouch-like dilatation of a shortened colon is associated with an anorectal malformation. It is categorized into four subtypes (Types I–IV) based on the length of normal colon proximal to the colonic pouch. In males, the pouch usually terminates in a colovesical fistula just proximal to the bladder neck. In girls, the terminal fistula opens either into the urethra or in the vestibule, close to the urethral opening. Girls usually have a double vagina with a wide inter-vaginal bridge, a monocornuate uterus on each side, and urinary incontinence due to a widely open bladder neck. Associated major malformations are uncommon with CPC but sometimes, especially in reports from outside India, major abnormalities are present suggesting an early, severe error in embryogenesis. The more severe Types I/II CPC can usually be diagnosed by a large gas shadow or air-fluid level on X-Ray abdomen. For all subtypes of CPC, it is preferable to preserve a segment of the pouch by fashioning a narrow colonic tube for pull-through, the technique known as coloplasty or tubular colorraphy. Girls need additional management of the genitourinary abnormalities. Postoperatively, fecal continence levels are usually poor, especially with Types I/II CPC.
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Affiliation(s)
- Rajiv Chadha
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
| | - Niyaz Ahmed Khan
- Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India
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Management options of congenital pouch colon--a rare variant of anorectal malformation. Pediatr Surg Int 2015; 31:753-8. [PMID: 26137872 DOI: 10.1007/s00383-015-3739-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Congenital pouch colon (CPC) was analysed for anatomical variations and surgical options. METHODS Records of CPC patients managed between 1999 and 2014 were studied. CPC was classified as complete (CCPC) and incomplete (ICPC) pouch. RESULTS Of 400 cases of high anorectal malformations, 68 cases were CPC (17%). Male:female ratio was 2:1. Fistulous communication was colovesical, colocloacal, colovaginal and absent in 42, 15, 8 and 3 cases. ICPC and CCPC was 48 (70%) and 20 (30%). In neonatal period, proximal/end colostomy (31), ileostomy (6), pouch excision with abdominoperineal pull-through (18 cases) and coloplasty with end colostomy (7) were done. 6 presented as infants including 3 referred cases of CCPC with a window colostomy. Definitive surgery was completed in 56. Severe colonic dilatation after coloplasty was noted in 5, requiring excision of coloplasty segment in 2. Histopathology of excised pouch (45) showed muscle layer disorganization, widened sub mucosa, prominent vasculature and mature and immature ganglion cells, with no hypertrophy of nerve fibres. Diarrhoea and faecal incontinence (soiling) were more frequent in patients with CCPC versus ICPC. Six neonates with CCPC died. Six are awaiting definitive surgery. CONCLUSION CPC had 8.8% neonatal mortality. Pouch excision and definitive procedure are feasible in neonates with CPC. Coloplasty in CCPC may result in postoperative colonic dilatation.
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Pandey V, Gangopadhyay AN, Gupta DK, Sharma SP. Single stage management of a unique variant of congenital pouch colon with triplet fistula and normal anus. J Indian Assoc Pediatr Surg 2015; 20:148-9. [PMID: 26166988 PMCID: PMC4481629 DOI: 10.4103/0971-9261.154665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Congenital pouch colon (CPC) in the female patient presents with highly variable and anomalous anatomy. We herein report the first case of CPC with uterus didelphys having normal anal opening, H-type vestibular fistula, two other fistulous communications between pouch colon and two vagina managed in a single stage with excellent postoperative outcome.
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Affiliation(s)
- Vaibhav Pandey
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ajay Narayan Gangopadhyay
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Dinesh Kumar Gupta
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Shiv Prasad Sharma
- Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Laparoscopic assisted anorectal pull-through for treatment of congenital pouch colon: Two cases in central China. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Witvliet MJ, Slaar A, Heij HA, van der Steeg AFW. Qualitative analysis of studies concerning quality of life in children and adults with anorectal malformations. J Pediatr Surg 2013; 48:372-9. [PMID: 23414868 DOI: 10.1016/j.jpedsurg.2012.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Anorectal malformations are relatively common congenital anomalies in pediatric surgery. After definitive surgery constipation, soiling, and fecal incontinence are frequently seen problems. Quality of life (QoL) can be influenced by these problems. In the last decades QoL has become an important aspect in the treatment and follow-up of patients with anorectal malformations. This has resulted in various reports concerning QoL. In order to deduce whether the drawn conclusions in the different studies are correct and can be used to adjust standard care for patients with ARM, a qualitative analysis of the studies was performed. MATERIAL AND METHODS A literature study was performed in PubMed, Psychinfo, Web of Science, and the Cochrane Library (240 hits). Thirty articles were used, following application of our inclusion criteria and in-depth analysis of the articles. A methodological qualitative analysis was also performed and QoL outcome assessed. RESULTS Six authors (20.0%) used validated QoL questionnaires. Four articles were longitudinal and had more than one measure moment. Eleven studies (36.7%) used only non-validated questionnaires, and eight studies (26.6%) used only validated questionnaires. Nineteen studies correlated fecal continence to QoL, and seven studies established no correlation. Three of these seven studies used validated QoL questionnaires. All twelve studies, which did establish a correlation, used non-validated QoL questionnaires. CONCLUSIONS Approximately 83% of the studies had not used validated QoL questionnaires. Further, conclusions concerning QoL were often based on functional outcomes, for example fecal incontinence. So far, longitudinal high quality research on QoL in this group has not been achieved.
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Affiliation(s)
- Marieke J Witvliet
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital AMC and VU University Medical Center, Amsterdam, The Netherlands
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Study of pelvic floor and sphincter muscles in congenital pouch colon with the help of three-dimensional CT scan. Pediatr Surg Int 2010; 26:1211-5. [PMID: 20857297 DOI: 10.1007/s00383-010-2732-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Congenital pouch colon (CPC) is a pouch-like dilatation of shortened colon associated with anorectal malformation (ARM). The disease is prevalent in northern India. Postoperatively, the continence results are not as good as in other ARMs and there is higher incidence of incontinence and perineal soiling in these patients. The present study aimed to evaluate the pelvic floor and sphincter muscle characteristics in patients of CPC with the help of 64-slice computerized tomography with three-dimensional (3D) volumetric reconstructions of images, thus, to know the overall quality of these muscles in the patients. MATERIALS AND METHODS The study was conducted in patients admitted over a period of July 2007 to November 2008 in our department. Totally, eight patients of CPC were subjected to 64-slice CT with three-dimensional reconstructions of images and different parameters such as quality of pelvic floor muscles, configuration of vertical and parasagittal fibres, shape and thickness of sphincter muscle complex, attenuation values of sphincters were studied. RESULTS The 3D reconstructed images of pelvis in patients of CPC showed a well-developed pelvic floor and sphincter muscle complex. The length of the parasagittal fibres, transverse width of the vertical fibres and CT attenuation values of these structures with overall muscle quality were found to be good in these patients. CONCLUSION In cases of CPC, the pelvic floor muscles including striated muscle complex (vertical and parasagittal fibres) are well developed. Higher rates of incontinence and soiling in CPC are not because of poorly developed pelvic floor and sphincter muscles. Three-dimensional CT can also provide important anatomical information that can help the operating surgeon while performing surgery.
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Shakya VC, Agrawal CS, Koirala R, Khaniya S, Poudel P, Adhikary S. A report of a rare congenital malformation in a Nepalese child with congenital pouch colon: a case report. CASES JOURNAL 2009. [PMID: 20181156 PMCID: PMC2827101 DOI: 10.1186/1757-1626-2-6424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Congenital pouch colon is one of rare congenital anomalies. We report a 3-day-old male child with congenital pouch colon who underwent a window colostomy but died because of overwhelming sepsis. Due to its rarity, many surgeons in our part of the world may not be aware of it, hence increasing the potential to its mismanagement. However, with simple keen observations, we can safely come to its diagnosis. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation in our country, with a brief emphasis on an approach to its diagnosis and initial management.
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Tyagi P, Mandal MB, Mandal S, Patne SCU, Gangopadhyay AN. Pouch colon associated with anorectal malformations fails to show spontaneous contractions but responds to acetylcholine and histamine in vitro. J Pediatr Surg 2009; 44:2156-62. [PMID: 19944226 DOI: 10.1016/j.jpedsurg.2009.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 04/24/2009] [Accepted: 04/26/2009] [Indexed: 11/17/2022]
Abstract
PURPOSE Congenital pouch colon (CPC) associated with anorectal malformation (ARM) is most commonly reported from Northern India. So far, no physiologic study comparing the detailed contractile status of CPC with non-CPC conditions are available. The present article deals with the contractile study and histopathologic observations in CPC, which may be useful for better surgical management. METHODS Freshly excised 12 neonatal CPC and similar number of non-CPC (control) specimens were transferred to ice-cold (4 degrees C-6 degrees C) Krebs-Ringer solution bubbled with 100% oxygen. Longitudinally prepared 2 to 4 colonic strips were obtained from central part of each specimen and subjected to the contraction recording after exposure to cumulative concentrations of acetylcholine (ACh) and histamine. Acetylcholine-induced contractions were evaluated after application of atropine (muscarinic blocker), and histaminergic contractions were recorded after pheniramine (H(1) blocker), lignocaine (neuronal blocker), and atropine. Histopathologic observations were made by using H&E and Masson trichrome stains. RESULTS Control specimens showed spontaneous contractions, but CPC strips did not. Both control and CPC responded to ACh and histamine. The response to histamine was greater (P < .05) in CPC as compared to control, whereas the response to ACh was more (P < .05) in control. In CPC, response of histamine (100 micromol/L) was blocked by pheniramine (0.32 mmol/L) and lignocaine (4 mmol/L) by 97% and 80%, respectively, and enhanced by 57% after preapplication of atropine (10 micromol/L). Acetylcholine (100 micromol/L)-induced contractions were attenuated (86%) in presence of atropine. Histopathologic examination showed fewer mature ganglion cells with various changes in muscle layers including fibrosis, disruption, hypertrophy, atrophy, and constriction bands. CONCLUSION Congenital pouch colon associated with ARM lacks normal spontaneous contractions but retains ACh and histamine-induced contractility. In view of the functional and histologic abnormalities, we propose that CPC associated with ARM is an abnormally functional and developed tissue. Therefore, resection of the pouch should be considered for better functional outcome of the remaining bowel.
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Affiliation(s)
- Preeti Tyagi
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, UP, India
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Kazez A, Ozel SK, Bakal U, Sarac M. Abdominotransanal approach to pouch colon associated with rectal atresia. J Pediatr Surg 2009; 44:E19-21. [PMID: 19524712 DOI: 10.1016/j.jpedsurg.2009.02.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 02/11/2009] [Accepted: 02/28/2009] [Indexed: 11/19/2022]
Abstract
Pouch colon anomaly and high anorectal malformation are well-defined rare anomalies. The association of pouch colon anomaly with rectal atresia has previously been defined in only one case. In this study, a 2-day-old baby is presented with pouch colon anomaly without fistula and with rectal atresia. As a second case in the literature, this pathologic condition has been treated through the abdominotransanal route by using a single-stage endorectal coloanal pull-through. Being uncommon and having an important therapeutic approach, this case has been evaluated as worth presenting.
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Affiliation(s)
- Ahmet Kazez
- Department of Pediatric Surgery, Firat University, Faculty of Medicine, Elazig, Turkey.
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15
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A report of a rare congenital malformation in a Nepalese child with congenital pouch colon: a case report. CASES JOURNAL 2009; 2:6424. [PMID: 20181156 DOI: 10.1186/1757-1626-0002-0000006424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 02/03/2009] [Indexed: 11/10/2022]
Abstract
Congenital pouch colon is one of rare congenital anomalies. We report a 3-day-old male child with congenital pouch colon who underwent a window colostomy but died because of overwhelming sepsis. Due to its rarity, many surgeons in our part of the world may not be aware of it, hence increasing the potential to its mismanagement. However, with simple keen observations, we can safely come to its diagnosis. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation in our country, with a brief emphasis on an approach to its diagnosis and initial management.
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16
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Abstract
PURPOSE This paper aims to present the modified technique of coloplasty for congenital short colon (CSC) and analyse the long-term results of this operative procedure. METHODS A total of 310 patients of CSC have been admitted to out department between 1975 and 2007; 138 have been treated by the modified technique of coloplasty. Seven patients expired after coloplasty and nine are awaiting ileostomy closure. One hundred and twenty-two have completed all stages of surgery (study group). In these patients, three-stage surgical management (window colostomy, coloplasty with ileostomy and ileostomy closure) was performed. The range of follow-up is from 2 months to 18 years. The patients have been observed for: quality of muscle at the time of PSARP, Kelly's continence score, growth and development, schooling and social interactions and complications. Contrast study of the coloplasty tube has been done at different stages during follow-up with observation of colon diameter, evidence of peristalsis and colon emptying. RESULTS Ninety-seven patients from the study group have good quality of life, normal growth and development, where appropriate, they go to school and have normal social interactions. Using Kelly's scoring system, the results are good in 97 (stool frequency up to 3/day, no perineal excoriation, no soiling), fair in 9 (stool frequency 3-5/day, occasional perineal excoriation and occasional soiling) and poor in 16 (continuous stooling, soiling, perineal excoriation or complications). Complications include perineal dehiscence needing permanent colostomy (n=1), closure of the distal end of the coloplasty tube requiring revision (n=2), adhesive intestinal obstruction requiring re-exploration (n=2). Additionally intractable perineal excoriation (n=8), colonic dilatation requiring pouch excision and conversion to ileal 'S' pouch (n=2) and failure to thrive (n=4) were also seen. CONCLUSIONS Congenital short colon is the most severe colonic malformation barring cloacal exstrophy; however, good quality of life can be offered to these patients by coloplasty. The important technical step is to make the colonic tube long and small in diameter, so that it can propel stools and resist dilatation. These steps have been highlighted in the paper.
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Al-Salem AH. Unusual variants of congenital pouch colon with anorectal malformations. J Pediatr Surg 2008; 43:2096-8. [PMID: 18970947 DOI: 10.1016/j.jpedsurg.2008.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Anorectal malformations are common worldwide. Several classifications were used to describe the different types, but in spite of this, there are rare variants. This report describes 2 unusual cases of congenital pouch colon and anorectal malformations.
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Affiliation(s)
- Ahmed H Al-Salem
- Department of Pediatric Surgery, Maternity and Children's Hospital, Dammam, Qatif 31911, Saudi Arabia.
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Demirogullari B, Ozen IO, Afsarlar C, Moralioglu S, Poyraz A, Sonmez K, Kale N, Basaklar AC. Congenital pouch colon associated with anorectal malformation: report of 2 cases. J Pediatr Surg 2007; 42:E13-6. [PMID: 17923182 DOI: 10.1016/j.jpedsurg.2007.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Congenital pouch colon associated with anorectal malformation is an unusual anomaly reported most frequently in Asian countries. Pediatric surgeons must be familiar with this anomaly and the pre- and postoperative problems of these patients. The aim of this report is to bring attention to congenital pouch colon associated with anorectal malformation by discussing experiences with 2 patients.
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Affiliation(s)
- Billur Demirogullari
- Department of Pediatric Surgery, Gazi University Medical Faculty, Ankara, Turkiye.
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