Type IV Congenital Pouch Colon in Male Children: Anatomical Variations and a Proposed New Subclassification.
Anal stenosis
anorectal malformation
congenital pouch colon
fecal continence
Journal
Journal of Indian Association of Pediatric Surgeons
ISSN: 0971-9261
Titre abrégé: J Indian Assoc Pediatr Surg
Pays: India
ID NLM: 101179870
Informations de publication
Date de publication:
Historique:
received:
02
09
2018
revised:
05
10
2018
accepted:
29
12
2018
entrez:
4
1
2020
pubmed:
4
1
2020
medline:
4
1
2020
Statut:
ppublish
Résumé
Congenital pouch colon (CPC) is a rare variant of anorectal malformation. In male patients, CPC communicates distally with the urogenital tract by a large fistula. The CPC cases which do not fulfill the criteria as mentioned in the classical description are reported along with the pertinent literature review. This was a retrospective study from January 2004 to December 2017 of male children with Type IV CPC. We evaluated clinical presentation, primary management, anatomical relationship, previous surgical intervention, definitive management, result, and outcome in terms of continence status on Templeton score. Fifty-one children were included in the study among whom 36 children (Group 1) had a colovesical fistula and 15 children (Group 2) had no communication of the pouch with the genitourinary tract. In Group 2 children, the clinical presentations and management were varied: 4 underwent primary pull-through procedure, whereas 11 underwent staged procedure. Group 2 included three children in whom a narrow and thin-walled anal canal or anal canal with lower rectum was present, which was incorporated during the pull-through procedure. On continence assessment, only one child in Group 1 had "good" continence score compared to four children (three having anal canal) in Group 2. CPC Type IV can present without genitourinary tract communication (fistula), contrary to its emblematic description. Awareness about anatomical variations and adaptation of surgical technique accordingly is vital. The identification of the anal canal with or without the lower part of the rectum (even though apparently narrow and thin walled) and incorporation of this in bowel continuity lead to better outcomes in terms of continence.
Sections du résumé
BACKGROUND
BACKGROUND
Congenital pouch colon (CPC) is a rare variant of anorectal malformation. In male patients, CPC communicates distally with the urogenital tract by a large fistula. The CPC cases which do not fulfill the criteria as mentioned in the classical description are reported along with the pertinent literature review.
MATERIALS AND METHODS
METHODS
This was a retrospective study from January 2004 to December 2017 of male children with Type IV CPC. We evaluated clinical presentation, primary management, anatomical relationship, previous surgical intervention, definitive management, result, and outcome in terms of continence status on Templeton score.
RESULTS
RESULTS
Fifty-one children were included in the study among whom 36 children (Group 1) had a colovesical fistula and 15 children (Group 2) had no communication of the pouch with the genitourinary tract. In Group 2 children, the clinical presentations and management were varied: 4 underwent primary pull-through procedure, whereas 11 underwent staged procedure. Group 2 included three children in whom a narrow and thin-walled anal canal or anal canal with lower rectum was present, which was incorporated during the pull-through procedure. On continence assessment, only one child in Group 1 had "good" continence score compared to four children (three having anal canal) in Group 2.
CONCLUSION
CONCLUSIONS
CPC Type IV can present without genitourinary tract communication (fistula), contrary to its emblematic description. Awareness about anatomical variations and adaptation of surgical technique accordingly is vital. The identification of the anal canal with or without the lower part of the rectum (even though apparently narrow and thin walled) and incorporation of this in bowel continuity lead to better outcomes in terms of continence.
Identifiants
pubmed: 31896893
doi: 10.4103/jiaps.JIAPS_189_18
pii: JIAPS-25-10
pmc: PMC6910055
doi:
Types de publication
Journal Article
Langues
eng
Pagination
10-14Informations de copyright
Copyright: © 2019 Journal of Indian Association of Pediatric Surgeons.
Déclaration de conflit d'intérêts
There are no conflicts of interest.
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