Congenital pouch colon associated with segmental dilatation of the colon

Congenital segmental dilatation of the intestine: an in-depth review

OBJECTIVE

Congenital segmental dilatation of the intestine (CSDI) is a rare gastrointestinal condition. We conducted a scoping review through MEDLINE and Google Scholar, collecting data from 1959 through August 2020 to better understand this peculiar disease.

METHODS

The clinical and pathological features of 150 patients were reviewed.

RESULTS

The mean age was 25.9 days, and 61.3% of patients were male. An antenatal diagnosis was made in 15.3% of patients. Predominant symptoms included abdominal distension (83.9%) and vomiting (61.3%). Pallor and anemia were associated with ileal CSDI. The most common sites of the lesion were the ileum (56%) and colon (27.3%). Associated anomalies occurred in 57.3% of the patients, of which the most common included other abnormalities of the digestive system (69.8%), abdominal wall (19.8%), and cardiovascular system (11.6%). Resection and anastomosis was performed in 83.3% of patients. Postoperative complications occurred in 10%. Normal ganglion cells were commonly found (97.3%), while muscle layer hypertrophy and atrophy were found in 14.7% and 13.3% of the patients, respectively. Abnormal interstitial cells of Cajal were identified in four patients. Death occurred in 12.7% of patients. Demise was significantly associated with the duodenal location of CSDI (Mantel-Cox test, p = 0.002).

CONCLUSION

CSDI remains poorly understood, and mortality is associated chiefly with its duodenal location. Further research is needed, and biorepositories should be promptly set up to study this disease in the future better.

Congenital Pouch Colon: Case Series and Review of Evidences for Resection

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.

Congenital pouch colon in Duhok, outcome and complications: Case series

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.

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Congenital pouch colon is a rare disease that requires early diagnosis and treatment.

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Window colostomy at the pouch is better to be avoided due to high incidence of complications.

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Pouch tabularization and end colostomy has better outcome than other types of interventions.

Type V Congenital Pouch Colon: An Extremely Rare Variant of Anorectal Malformations

Type V is the rarest form of congenital pouch colon with only four cases reported till date. We report this anomaly in a 6-month-old boy. He was managed successfully with excision of distal pouch and coloplasty of proximal pouch along with abdominoperineal posterior sagittal anorectoplasty. We recommend preservation of proximal pouch in such cases.

Huge Congenital Segmental Dilatation of the Sigmoid Colon in a Neonate: A "Rarity to Meet" and a "Challenge to Treat"

Only ten cases of neonatal congenital segmental dilatation (CSD) of the colon have been described so far. We present a full-term female newborn with trisomy 21, ventricular septal defect, and gross abdominal distension. Plain abdominal radiographs revealed a huge cystic lesion occupying the left hemiabdomen. Upon laparotomy on day 4 a CSD of the distal sigmoid and proximal rectum was confirmed and resected. The proximal colon was exteriorized and the distal part closed as a Hartmann pouch. Histology confirmed a huge segmental dilatation of the sigmoid without dysganglionosis or pseudodiverticula, but normal intestinal architecture. After correction of the ventricular septal defect a low rectal end-to-end anastomosis could be performed at an age of 5 months. The postoperative course was uneventful. CSD of the sigmoid colon is extremely “rare to meet” and a “challenge to treat” in the newborn period, but clinical awareness of this entity prompts pediatric surgical success.

Congenital pouch colon and segmental dilatation of the colon: A report of two unusual cases

This report describes two unusual cases of anorectal malformation. The first had a type III congenital pouch colon with a colovesical fistula. In the other very similar case, segmental dilatation of the colon was present along with penoscrotal hypospadias and, distally, a length of normal colon ending in a rectourethral fistula. In both patients, the appendix was short, stubby and a Y-shaped duplication of the normal colon was present just proximal to the dilated segment of colon.

Segmental dilatation of sigmoid colon in a neonate: atypical presentation and histology

Segmental dilatation of the colon is a rare disorder of colonic motility in children, often presenting with severe constipation in older infants, children, and occasionally adults. It may mimic the commoner Hirschsprung disease clinicoradiologically but differs in that the ganglion cell morphology and distribution are typically normal in the colon. We report a neonate with segmental dilatation of the sigmoid colon who had an atypical clinical presentation and describe certain abnormalities in bowel histology (hypertrophied muscularis propria, nerve plexus, and ganglion cells located within the circular layer rather than the normal myenteric location), for the first time in the English literature.

Laparoscopic-assisted sigmoid resection for colonic ectasia in a neonate

A 2.7-kg, 2-day-old girl was diagnosed to have a colonic ectasia and malrotation. She underwent laparoscopic resection of the ectatic segment and Ladd procedure. To our knowledge, such a laparoscopic resection of a colonic ectasia in a neonate has not been reported previously in the English literature. The clinical features, management, and surgical technique will be discussed in this report.

A novel association of duodenal atresia, malrotation, segmental dilatation of the colon, and anorectal malformation

We describe two female neonates who suffered from four gastrointestinal anomalies, including duodenal stenosis or atresia, malrotation, segmental dilatation of the colon, and anorectal malformation. Each patient was managed by two or three operations, resulting in good bowel movements. Since this is the first report of four gastrointestinal anomalies, these cases may provide clues to elucidate the etiology of gastrointestinal tract developmental abnormalities.

Classification of congenital pouch colon based on anatomic morphology

BACKGROUND AND AIMS

Congenital pouch colon (CPC) is an extremely rare variant of anorectal malformation (ARM), in which varying lengths of the colon is replaced by a dilated pouch accompanied by a fistula communicating with the genitourinary tract. The aim of this study was to determine the incidence and prevalence of various forms of CPC and to classify it according to anatomic localization of malformation.

PATIENTS

During a period of 10 years, from 1996 to 2006, 390 patients with ARM were presented and managed at the Rabindra Nath Tagore Medical College, Udaipur, Rajasthan. CPC patients were identified at the time of presentation after abdominal films, and the anomaly was classified according to the form of pouch presentation only during surgical exploration.

RESULTS

Of the total number of ARM cases, the incidence of CPC was 17.2% (67 cases); however, it constituted 55.8% cases of high ARM. Among the CPC patients, type 1 was documented in 19 (28.4%), type 2 in 17 (25.4%), type 3 in two (3%), type 4 in 25 (37.3%), and type 5 in one (1.5%). Multiple large colon segmental dilatations were documented in one patient (1.5%); and in two patients (2.9%), the type of CPC was not known.

CONCLUSION

Classification based on the anatomic morphology has the advantage of identifying the pouch based on the segment of the colon involved, rather than the previous classification based on the length of the colon.

Congenital pouch colon syndrome: a report of 17 cases

BACKGROUND

Congenital pouch syndrome (CPC) is a rare condition seen in association with anorectal malformation that occurs almost exclusively in northern India. We reviewed cases seen in our institution to study aspects of clinical presentation, diagnosis, embryogenesis and management and raise awareness of this relatively infrequent entity.

PATIENTS AND METHODS

From March 2002 to September 2004, 17 neonates/infants (11 males and 6 females) treated for CPC associated with anorectal malformations included 13 with type IV and 4 with type I CPC. Diagnosis was made by a single large air-fluid level on the infantogram occupying more than 50% of the entire abdominal dimension.

RESULTS

In all patients, the pouch had fistulous communication with the genitourinary system, and there were other associated anomalies as well. Of 13 patients with pouch colon type IV, 11 neonates underwent laparotomy, ligation of the fistula, excision of the colonic pouch and end colostomy as a stage 1 procedure. Subsequently, these patients underwent definitive surgery, i.e. abdominoperineal posterior sagittal anorectoplasty (AP-PSARP), with or without covering colostomy. Two of 4 patients with type 1 CPC underwent laparotomy, ligation of the fistula and colorrhaphy as a first-stage operation before AP-PSARP. In our series, 4 patients were diagnosed intraoperatively and were treated in accordance with their operative findings. Post-operatively, there were no major complications except wound infection in some patients. There was one death that was not related to surgery.

CONCLUSION

There are variants of the anomaly, but the possibility of CPC needs to be kept in mind as a possible association with anorectal malformations.

Congenital segmental dilatation of the colon with anorectal malformation

Segmental dilatation of the colon is a rare entity. The authors report unique case of segmental dilatation of the cecum and ascending colon with high anorectal malformation in a newborn, and the possible embryogenesis of this condition is discussed.

Congenital pouch colon associated with anorectal agenesis

This article presents a review of the history and development of the various types of congenital pouch colon. Also described are the criteria for diagnosis, the treatment modalities and the results of follow-up studies to emphasize the post-operative problems. The problem of pre-operative and post-operative fecal incontinence is dealt with in more detail.