Assessment of nutritional status of patients of congenital pouch colon following definitive surgery

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.

Congenital pouch colon

“…[47] A more recent study from our center of 31 patients, at least 3 years old, showed severe fecal incontinence with continence score[52] of 5 or less in 20 patients (64.52%). [48] The remaining 11 patients (25.81%), including the 10 patients with Types III/IV CPC, had “poor” fecal continence. [52] There was a high incidence of malnutrition, especially “stunting” (low height-for-age) which was the most common in the 0–5 years age-group.…”

“…[52] There was a high incidence of malnutrition, especially “stunting” (low height-for-age) which was the most common in the 0–5 years age-group. [48] Patients with Types I/II CPC had a higher incidence of anemia and severe fecal incontinence than those with Types III/IV CPC. Patients with Types I/II CPC, managed by excision of the colonic pouch had a higher incidence of severe fecal incontinence and malnutrition than those with pull-through after TC, suggesting that the latter procedure has long-term benefit.…”

“…[61146] However, the extremely poor functional results following this management protocol and significantly better results after tubular colorraphy (TC) and pull-through,[4748] led us to opt for preserving the colonic pouch wherever possible. This has been the prevalent view throughout at other centers.…”

“…[124] Complications include major ileostomy losses, failure to thrive, severe peristomal excoriations,[48] and possible metabolic acidosis due to urinary reabsorption through the wide CVF. Use of oral rehydrating solutions and nutritional supplementation are essential[2948]…”

“…[124] Complications include major ileostomy losses, failure to thrive, severe peristomal excoriations,[48] and possible metabolic acidosis due to urinary reabsorption through the wide CVF. Use of oral rehydrating solutions and nutritional supplementation are essential[2948]TC and end colostomy[1] wherein the colonic pouch is tailored into a long tube to reduce redundancy, improve peristalsis, and preserve colonic length for its absorptive function. Wakhlu and Wakhlu[49] felt that in newborns, the pouch is thin-walled and the mortality with this procedure is high (30%–50%).…”