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Congenital colon pouch: antenatal diagnosis and videoassisted surgery: report of 2 cases

J. Lopater, M. Haddad, P. de Lagausie, JM. Guys

Department of Pediatric Surgery and Urology, La Timone Children Hospital, Marseilles, France

 

ABSTRACT

Introduction: The congenital pouch colon (CPC) is an anomaly associating an anorectal malformation (ARM) with a distal dilatation of the colon that has the aspect of a pouch. It is a sporadic anomaly, more frequent in male (2.4/1) and more frequent in certain areas of India where it accounts for 10% of the ARM. We report two cases of this anomaly.

Material and methods: The first case was a type 3 CPC (a healthy right colon upstream of a colic pouch fistulised in the prostatic urethra) diagnosed in a boy at birth and associated with an omphalocele and a Meckel’s diverticulum. The second was a type 3 CPC (13 cm of right healthy colon upstream of a colic pocket fistulised in a hemivagina) diagnosed in a girl by antenatal ultrasonography and associated with a bifid uterus.

Results: The first case was treated by coloplasty, closing the fistula and ileostomy in the first time surgery, then laparoscopic pull-through in the second time surgery. The second case was treated by colostomy and closure of the fistula with resection of the pouch by laparoscopy in the first time surgery then pull-through, anoplasty and ileostomy in the second time surgery. The reestablishment of intestinal continuity was possible at 3 years (intercurrent urinary complications) for the first and at 4 months for the second. The results are satisfactory with 6 months follow-up after the last intervention.

Discussion: The coloplasty (preserving a segment eventually less functional) or the resection of the colonic pouch are two attitudes that were used in the treatment of the CPC. A more important follow-up is necessary to evaluate the best attitude. The dissection, the fistula ligation and the colonic clevage for the pull-through were simplified by the use of the laparoscopy.

Conclusion: The CPC is a rare anomaly in Europe. The antenatal diagnosis can be assumed. The coloplasty can be discussed according to the length of the persisting colonic segment in order to improve the functional results.

 

Key words: congenital pouch colon, anorectal malformation, coloplasty