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At least 19 recordsLinked to original sources
PubMed2002

Congenital pouch colon: Massive redilatation of the tubularized colonic pouch after pull-through surgery.

BACKGROUND/PURPOSE: Children with a type I/II congenital pouch colon (CPC) malformation associated with imperforate anus usually are treated by subtotal excision of the colonic pouch, tubularization of the remaining portion, and pull-through of the tubularized colon during definitive surgery. The authors report 3 patients treated in this fashion who presented 2 to 10(1/2) years later with massive redilatation of the previously tubularized colon and enterocolitis METHODS: There were no anal strictures or malpositioning of the pulled through bowel. Contrast enema showed massive redilatation of the colonic pouch. Near-total excision of the redilated pouch with anastomosis of normal proximal ileum/colon with the retained distal portion of the pouch was performed by the abdominal approach. RESULTS: Anastomotic leaks occurred in 2 patients but were treated successfully. Postoperatively, the patients had relief from their abdominal symptoms and improvement in fecal continence. CONCLUSIONS: The colonic pouch in CPC has a marked tendency to undergo redilatation, even after tubularization. The surgical procedure described here for the treatment of these patients appears to be satisfactory.

Anus, Imperforate↗
PubMed2002

Unusual presentations of pouch colon.

Pouch colon associated with high anorectal malformation is a rare anomaly. Two unique anatomic variants of congenital pouch colon, never reported before, are presented.

Abnormalities, Multiple↗
PubMed2005

The histopathology of congenital pouch colon associated with anorectal agenesis.

The colonic pouch excised during surgery in 17 patients with congenital pouch colon associated with anorectal agenesis (CPC) was subjected to detailed histological examination after staining with hematoxylin and eosin. The patients included 11 newborns, 3 infants, and 3 older children. The most frequently observed abnormalities were acute and chronic inflammation of the mucosa and submucosa, focal or generalized thinning of muscle layers, especially of the outer muscle coat, disorganized muscle layers, a decreased number of mature ganglion cells, and neuronal hyperplasia and hypertrophy in nerve plexuses. Ectopic heteroplastic tissues were identified in 2 patients. These findings suggest that the colonic pouch in CPC represents abnormally developed colonic tissue and points to the similarity with segmental dilatation of the colon. The neuromuscular abnormalities explain the physiological characteristics of the colonic pouch, namely weak peristalsis as well as the propensity to undergo marked dilatation even after tubularization.

Child, Preschool↗
PubMed2006

Colostomy prolapse and hernia following window colostomy in congenital pouch colon.

Congenital pouch colon, a variant of anorectal malformation, is a rare anomaly with a high incidence in North India and although the anatomy and diagnostic features have been well described, the surgical treatment continues to be challenging. This report describes the complications following a less preferred but often practised surgical option-a temporizing window colostomy in three babies. A window colostomy predisposes to prolapse of the entire pouch colon with herniation of bowel loops, intestinal obstruction and failure to thrive. Depending on the state of the child, either a proximal diverting stoma or tubularization of the pouch with a terminal stoma is recommended as the procedure of choice for the initial surgical management of this complex and rare malformation.

Colon↗
PubMed2004

H-pouch: new isoperistaltic colonic pouch for coloanal anastomosis after rectal resection for cancer: a pilot study.

PURPOSE: To date, there is a consensus to consider colonic J-pouch-anal anastomosis as the standard form of reconstruction after proctectomy for cancer. However, one drawback of colonic J-pouch is evacuation difficulties, which are observed at some degree in almost one-half of patients. To improve functional outcome after coloanal anastomosis, we describe a new technique of isoperistaltic colonic H-pouch. METHODS: The functional results after construction of this pouch were assessed prospectively in ten patients and compared with those obtained in a control group of matched patients with a colonic J-pouch. RESULTS: At six months and one year, there were no differences between both pouches for bowel function, continence score, and evacuation difficulties. CONCLUSIONS: This preliminary study showed that the creation of a new isoperistaltic colonic H-pouch did not improve the functional results after coloanal anastomosis compared with colonic J-pouch. Because colonic H-pouch is technically more complex to fashion, it should not be performed routinely and the J-pouch remains the benchmark for routine clinical practice.

Adult↗
PubMed2000

Congenital short colon with imperforate anus (pouch colon). Report of a case.

We report a case of a persistent cloaca and pseudoexstrophy associated with congenital pouch colon in a native-born American female child. This unusual anomaly occurs in two clinical settings. It has been reported in India as an isolated anomaly occurring primarily in males. Pouch colon also occurs in female patients with pseudoexstrophy or closed cloacal exstrophy. The typical anatomic features of this anomaly are discussed.

Abnormalities, Multiple↗
PubMed2003

Duplication of pouch colon associated with duplication of the lower genitourinary tract.

The authors report on a baby with imperforate anus associated with duplication of descending colon, double pouch colon type IV, duplication of the urinary bladder, and a bifid penis. The interesting presentation of this problem and its management is discussed with a brief review of the probable embryologic basis for such an anomaly. Such a duplication of pouch colon has not been described previously.

Colon↗
PubMed1997

A report of 27 cases of congenital short colon with an imperforate anus: so-called 'pouch colon syndrome'.

This is a retrospective study of 27 cases of congenital short colon with anorectal malformation (pouch colon syndrome) treated during the last 5 years (from January 1991 to December 1995). The radiological feature of enormously dilated colonic pouch occupying more than half the width of abdomen was diagnostic in almost all cases. Excision of pouch and end enterostomy was associated with maximum survival (92.3%) in good risk patients. Proximal diverting enterostomy with decompression and irrigation of pouch is a preferable alternative to pouch colostomy in poor risk patients. Tapering coloplasty and colostomy should be reserved only for types I and II cases of pouch colon.

Abnormalities, Multiple↗
PubMed1998

Congenital pouch colon revisited.

BACKGROUND/PURPOSE: The authors' recent experience with the study of the presentation, the pathological anatomy, and results of management of congenital pouch colon (CPC) malformations is presented. The possible embryogenesis of this condition is discussed. METHODS: Between January 1991 and June 1997, CPC with anorectal agenesis was diagnosed in 39 patients, 27 boys and 12 girls, who were classified in four groups, based on the length of the normal colon proximal to the distended segment. In 31 patients with little or no normal colon, the choice of primary procedure was based on the condition of the infant and the viability of the colonic pouch. Definitive surgery has been performed in 15 patients from this group. The eight patients with a suitable length of normal colon had a lower level of termination of the colonic pouch and a lower fistula. In these, a colostomy was constructed just proximal to the pouch, with later definitive surgery in four patients consisting of excision of the colonic pouch and pull-through of the proximal colon. RESULTS: Mortality after primary surgery was 13%. Definitive surgery was well tolerated in all 19 patients. CONCLUSION: In patients in whom a tubularized segment of the colonic pouch was used, continence was only fair to poor a year later.

Colon↗
PubMed1999

A novel colon pouch and its comparison with a straight coloanal and colon J-pouch--anal anastomosis: preliminary results in pigs.

BACKGROUND: Early functional results after complete rectal resection and straight coloanal anastomosis are often characterized by frequent bowel movements, urgency, and varying degrees of stool incontinence. The formation of a colon reservoir improves early and long-term function. We evaluated the feasibility of a novel, modified design of a colon pouch--anal anastomosis in pigs and compared the results with those of pigs with straight coloanal anastomosis and colon J-pouch. METHODS: Complete rectal resection followed by either a straight coloanal anastomosis, a colon J-pouch, or a novel design of a colon pouch was performed in equal numbers in 15 pigs. By transversely closing a longitudinal colotomy, the new, technically simpler pouch is formed. Functional results were assessed during a period of 6 weeks. RESULTS: All 15 procedures were successful. The novel colon pouch required less surgical time than the colon J-pouch, and the formation of the pouches did not reduce tissue perfusion as assessed by laser Doppler flowmetry. The mean volume of the novel colon pouch was significantly smaller than the volume of the colon J-pouch. All the pigs with the novel colon pouch had normal stool frequency and consistency during a period of 6 weeks. In the group with straight coloanal anastomosis, two pigs had increased frequency of defecation, one pig showed signs of urgency and perianal dermatitis, and three had substantially reduced stool consistency. Of the four pigs with colon J-pouch, three had signs of impaired pouch evacuation and two had reduced stool frequency. CONCLUSIONS: The novel colon pouch is feasible in pigs and technically simpler than the colon J-pouch. These preliminary results indicate that the smaller capacity of this pouch seems sufficient for normal defecation. Its short-term functional results were better than those after reconstruction with a colon J-pouch or a straight coloanal anastomosis.

Anal Canal↗
PubMed2006

Congenital pouch colon: follow-up and functional results after definitive surgery.

PURPOSE: In this study, functional results with regard to fecal continence levels and other parameters were studied in 22 patients with congenital pouch colon associated with anorectal agenesis (CPC) more than 3 years old who had undergone definitive pull-through surgery 1 to 13 years earlier. An attempt was made to formulate treatment protocols for management of fecal incontinence and other problems associated with CPC. METHODS: The study sample consisted of 14 males and 8 females. Three of the 8 female patients had had a cloacal malformation. The medical records of the patients were scrutinized and they were classified into 4 subtypes based on the length of normal colon proximal to the colonic pouch. The patients were further categorized into 3 groups based on the terminal bowel that had been pulled-through, namely, the ileum or colon proximal to the colonic pouch or a tubularized segment of the colonic pouch. The somatic growth of the patients was studied. Clinical assessment of fecal continence was performed by the Kelly and the Kiesewetter and Chang scoring systems. A computed tomographic scan of the pelvis with a barium enema was performed to assess the terminal bowel and its placement as well as the bony and muscular anatomy of the pelvis. The urinary system was assessed by a clinical history as well as by abdominal ultrasound and a micturating cystourethrogram. Various treatment modalities including dietary modifications, drugs, and enemas were instituted in patients with poor continence levels, and the response to treatment studied. RESULTS: Thirteen patients (59.2%), all with an ileal pull-through, had height and weight less than 50% of that expected for their ages. Overall fecal continence was "poor" in 17 patients and "fair" in only 5 patients. Patients with pull-through of either ileum or normal colon often had very frequent passage of liquid or semisolid stools, whereas the 4 patients with pull-through of tubularized colon had infrequent passage of semisolid stools with abdominal distension and bloating. One of these 4 patients had massive colonic redilatation necessitating surgical correction. Mucosal prolapse and perineal excoriations were frequent findings. Ultrasonography and micturating cystourethrogram showed hydroureteronephrosis and vesicoureteric reflux in 5 patients. Radiologic assessment revealed that there were no significant sacral abnormalities and the striated sphincteric musculature was well developed, although the levator ani was thinner than normal in 15 patients (68%). The bowel was very well placed in the sphincteric complex in 19 patients (86%). In 7 of the 13 patients who had pull-through of normal ileum or colon, some improvement in continence levels was seen 3 to 6 months after institution of dietary measures, loperamide, and saline-water enemas. Two of 3 patients with pull-through of tubularized colon improved to some extent with colonic washouts alone. Overall, quality of life was poor in the 22 patients. CONCLUSIONS: Despite the fact that the sacrum is usually normal, the sphincteric musculature well developed, and the terminal bowel well placed without any anal strictures, long-term prognosis with regard to fecal continence, growth and development, and quality of life appears to be dismal for all subtypes of CPC, irrespective of the type of definitive surgery performed. Corrective measures also appear to be of limited value. Various newer management modalities for management of fecal incontinence may be considered, but in several patients a permanent abdominal stoma may be a more practical solution.

Adolescent↗
PubMed2004

"Pouch colon patch graft"--an alternative treatment for congenital short colon.

A patch graft of the pouch colon over the pulled-through ileum in a patient with long-length pouch colon (in whom the entire colon was replaced by a pouch that communicated with the urinary bladder) was tried with good results for the first time. At follow-up the patient was found to have normal bowel patterns and weight gain. Though colon patch grafts have been widely used in patients with total colonic aganglionosis, they have not been tried for the short colon. The authors discuss the clinical setting in which the procedure may prove useful in patients with pouch colon and why these patch grafts may yield comparable or even better results in patients with pouch colon compared with those with total colonic aganglionosis.

Anastomosis, Surgical↗
PubMed1999

Colonic pouch vs. side-to-end anastomosis in low anterior resection.

PURPOSE: Colonic pouches have gained increasing popularity in reconstruction after low anterior resection. In this prospective, randomized trial colonic pouch reconstruction is compared with side-to-end anastomosis for functional outcome. METHODS: From October 1995 to October 1996, 29 patients had colonic pouch and 30 patients had side-to-end anastomosis reconstruction after low anterior resection. Patients were matched for age, gender, and tumor stage and localization. All patients underwent functional evaluation preoperatively and at three and six months postoperatively. RESULTS: There was no difference in preoperative anorectal function. The operating time was higher in the colonic pouch group (167 vs. 149 minutes). Twenty-three patients (79.3 percent) with colonic pouch had a protective stoma compared with 21 patients (70 percent) with side-to-end anastomosis. Postoperative complications were 10.3 and 13.3 percent, respectively. There was no difference in manometric pressure of the anus, in anorectal angle, and in continence status after three and six months. Stool frequency was higher in the side-to-end anastomosis group, with 2.2 vs. 5.4 per day at three months and 2.3 vs. 3.1 per day at six months. Constipation was noted in two patients with colonic pouch (7 percent) and none in the side-to-end anastomosis group at three months and two vs. none at six months. Maximum tolerated volume and threshold volume was higher in the colonic pouch group at three and at six months. CONCLUSION: Both forms of reconstruction have similar satisfactory long-term functional results. The major advantage of colonic pouch was seen in the immediate postoperative phase.

Adult↗
PubMed1999

Congenital pouch colon in females.

From January 1995 to March 1998, congenital pouch colon (CPC) with anorectal agenesis was diagnosed in ten girls who were classified into four groups based on the length of normal colon proximal to the colonic pouch. Of six girls with little or no normal colon, one had a cloacal anomaly while five had a colovesical or colovestibular fistula along with a completely bifid uterus and cervix and a septate vagina. Initial surgery consisted of ligation of the fistula and subtotal pouch excision with tubularization of the remaining colon in four girls, ileostomy after excision of a gangrenous pouch in one, and window colostomy in another. None of the patients had a sacral abnormality or associated major malformation. Definitive surgery using the posterior sagittal approach consisted of a pull-through of the tubularized colon in three girls (including one in whom one-stage cloacal reconstruction was performed), the ileum in one, and the proximal colon in another. The four girls with a longer length of normal colon had an associated vestibular fistula. In these, a colostomy was constructed just proximal to the pouch with definitive surgery in two patients consisting of excision of the pouch and pull-through of the proximal colon. Definitive surgery was well tolerated in all seven patients. The embryogenesis of this condition and the related genitourinary tract abnormalities are discussed.

Abnormalities, Multiple↗
PubMed1994

The embryology and management of congenital pouch colon associated with anorectal agenesis.

Forty-one infants with a pouch colon malformation accompanied by a high anorectal anomaly were treated between January 1986 and December 1990. The 41 cases constituted 9% of all anorectal malformations and 15.2% of high defects managed during this period. There were 32 boys and nine girls; three of the girls had an associated cloaca. Many of the babies presented in poor condition, with gross abdominal distension caused by the distended colonic pouch. The typical radiological feature was an enormously distended colonic shadow occupying more than 50% of the width of the abdomen. At the time of surgery, the patients were classified into 4 subgroups based on the length of the normal colon. All but three infants had a high wide fistula, with the genitourinary tract consisting of a colovesical fistula in males and a colovaginal or colocloacal fistula in females. Frequent associated malformations included duplication of the appendix and vesicoureteric reflux. The operations performed initially were a window colostomy of the pouch with or without division-ligation of the fistula, end-colostomy after fistula ligation, or subtotal pouch excision with tubularization of the remaining colon and end-colostomy. Thirteen of the 41 patients have undergone a definitive pull-through operation using the posterior sagittal approach, including two children in whom one-stage reconstruction of a cloaca was performed. Standardized management of this complex anomaly is proposed for the initial operation and for definitive reconstruction.

Abnormalities, Multiple↗
PubMed2001

Congenital pouch colon associated with segmental dilatation of the colon.

A 1-day-old boy who presented with an anorectal malformation (ARM) was found to have a segmental dilatation of the colon (SDC) associated with a typical congenital pouch colon (CPC) malformation. The distal colonic pouch terminated in a high colovesical fistula. The posterior portion of the perineal raphé was duplicated and ended in 2 anal dimples. Both dilated segments of the colon were excised. The similarity between CPC and SDC is highlighted, and the possible embryogenesis of both conditions is discussed.

Colon↗
PubMed2005

Single-stage management of all pouch colon (anorectal malformation) in newborns.

BACKGROUND/PURPOSE: The standard procedure in the management of pouch colon is the staged procedure (SP), which has well-known disadvantages. We believe that staging is unnecessary and primary single-stage procedure (PSSP) can be done. METHODS: Patients with pouch colon who underwent PSSP (102 cases from 1997 to 2003) and SP (98 cases from 1991 to 1997), 63 and 42 of whom, respectively, were in regular follow-up for more than 3 years, were evaluated. RESULTS: In PSSP, male/female ratio was 94:8; in SP, 89:9. Mean age in PSSP was 4.6 days and in SP 26 months. The distribution of cases into types I, II, III, and IV was 10, 24, 14, and 15 in PSSP, and 8, 20, 10, and 4 in SP, respectively. The ratio of PSSP/SP for total pouch colon (I and II) was 34:28 and for partial pouch colon (III and IV) was 29:14. The ratio of PSSP/SP in terms of continence, mortality, and cost was 75:48, 11:47, and 1:4, respectively. CONCLUSIONS: Primary single-stage procedure gives better continence and cosmesis, with low morbidity and mortality at a low cost, and hence is recommended.

Anal Canal↗