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Rectal and colonic atresia: new indication of the Soave endoanal pull-through

M. Gasmi, F. Fitouri, R. Jemaï, N. Sghaïroun, S. Sahli, A. Essid, M. Hamzaoui

Department A of Pediatric Surgery, Children Hospital, Tunis, Tunisia



Introduction: The recto-colic atresia represents a rare cause of occlusion in newborns. Their treatment is surgical, by abdominal or sacro-perineal approach. The endoanal Soave procedure was introduced in 1998 in the treatment of the Hirschsprung disease and generally allows one time surgery in the first weeks of life without abdominal approach or initial diversion.

Material and methods: The authors report two particular observations, treated according to the Soave procedure by endoanal approach.

Results: Two 4 months old infants were admitted at the age of 2 days for neonatal occlusion with a distended abdomen and anus in normal position. The test with the rectal probe was negative and the probe stopped respectively at 15 and 40 mm from the anal edge. The thoraco-abdominal radiography showed a diffuse intestinal distension with multiple hydroaeric levels and a no air into the rectum. The laparotomy found a small intestine and colonic distension upstream of a rectal atresia in one case and of a sigmoid atresia in the second case. A right transverse colostomy was made in both cases. A Soave endoanal pull-through of the colon way was performed at age of 4 months followed by reestablishment of the digestive continuity. The evolution was favorable with a follow-up of 12 and 13 month.

Conclusion: The advantages of the Soave endoanal pull-through are multiple and explain its rapid diffusion and adoption by the majority of the pediatric surgeons. This surgical procedure represents a therapeutic innovation in the treatment of the colorectal atresias and stenosis.


Key words: colic atresia, endoanal Soave, pull-through