Congenital pouch colon: antenatal diagnosis and video-assisted management

Abstract

Congenital pouch colon (CPC) is an unusual abnormality associating a pouch-like dilatation of a shortened colon with an anorectal malformation (ARM). There are few reports of CPC in Europe, a contrario it represents up to 15% of ARM in India. Coloplasty and excision are described in the surgical management. This report describes a new case of CPC. This is the first reported case with a prenatal clinical presentation as an hypoechogenic abdominal image at ultrasound and a video-assisted management.

The anomalous clinical anatomy of congenital pouch colon in girls

“…This typical appearance, especially in regions such as north India where CPC is common, along with the characteristic radiologic features should alert the clinician to the presence of a CPC malformation. In newborn girls with CPC, if plain x-ray films of the abdomen are not conclusive, US and/or magnetic resonance imaging scan, such as described in a recent article [38], may help in making a definitive preoperative diagnosis of CPC. In addition, girls with CPC may present for the first time beyond infancy.…”

Congenital pouch colon

“…[12] Recently, laparoscopic- assisted anorectoplasty (LAARP) for Type III CPC has been described,[1951] the entire procedure being carried out with the patient in the supine-lithotomy position. A similar procedure can be performed with laparotomy, avoiding changes in the patient's position.…”

Antenatal diagnosis of congenital pouch colon: a case report from the Indian subcontinent with insights into management

“…Hence, only a few cases of antenatal diagnosis of CPC have been reported. 1 , 2 In our case, CPC was suspected on a routine antenatal growth scan ultrasound in the late third trimester, showing a hypoechoic tubular-shaped lesion in the pre-sacral region. With this suspicion, we suggested an institutional delivery at a tertiary level centre, and diagnosis of type III CPC was confirmed on post-delivery imaging and emergency primary surgery, done on the day 3 of life (pouch resection, division of fistula, and protective colostomy).…”

“… 3 It constitutes 6%-15% of total cases of ARM in India. 2 , 3 Type 3 CPC is described as normal ascending and transverse colon opening into the dilated pouch colon, according to the classification by Mathur et al 2 , 5 , 6 …”

“…Frequently, other malformations can also be found in association with CPC: vesicoureteral reflux in 6%, intestinal malrotation in 3%, hypospadias in 3%, sacral agenesis in 3%, and Meckel’s diverticulum in 2%. 2 , 3 …”