Introduction : The colon is replaced by a pouch-like dilatation associated with anorectal agenesis. Communicates with the urogenital tract by a large fistula. Incidence : It varies in different parts of the world. Northern part of the Indian, Sporadic case China, Japan, Sweden, UK and USA Pouch colon is more common in males Etiology and Embryogenesis The exact embryogenesis is not known. Trusler obstruction Because of chronic Chatterjee Primary disorder of the proximal end of the hindgut . A genetic predisposition needs to be ruled out.
The high density of cases in the northern belt of Indian points towards environmental factors with deficiency of iodine or vitamin B. Classification CPC should have the following anatomical criteria: 1. Anorectal agenesis. 2. The colon is short . 3. Pouch formation for a varying length. 4. Wall is thick and muscular with hypertrophied mucosa. 5. The fistula with the genitourinary tract is large, muscular and long. 6. The pattern changes suddenly and sharply. There is no transitional zone between the pouch colon and the normal bowel. Types : Management.
The aim of surgery Is to utilize the available length of colon for absorption and storage capacity as well as for propelling fecal matter onward with a continent anal opening. Incomplete CPC, the pouch can be excised Complete CPC , tubularizing the pouch in the form of Coloplasty. Technical skill, the availability of facilities and post-operative care. May direct the options COMPLICATION 1. leak following coloplasty . 2. wound dehiscence occurs in 4-5%. 3. Mortality –previously 40 %,now come down to 20 %. 4. Colonic dilatation in long-term follow-up. 5.
Improper function. CASE PRESENTATION Hassan Hasheem 4 years old male child from Talaffar with ARM AND CONGENITAL POUCH COLON Past surgical history: At the neonatal peroid – Abdominal distention -Failure to pass meconium Invertography: Show high type IA ,with the presence of large dilated pouch occupying most of the lower abdomen. Erect abdominal X ray : Show dilated bowel shadow occupying most of the lower abdomen 1. First stage: LAPAROTOMY : Neonatal period. An ileostomy opened just proximal to the cecuam at the same incision of the laparotomy to the left.
2. SECOND STAGE: 2 years old. A. Posterior Sagital Approuch 2. SECOND STAGE : A. Posterior Sagital Approuch 2. SECOND STAGE A. Posterior Sagital Approuch 2. SECOND STAGE B. Laparotomy 2. SECOND STAGE B. Laparotomy Ligation Of The Fistula 2. SECOND STAGE B. Laparotomy: Ligation Of The Blood Vesseles A : Coloplasty procedure to lengthen the colon while preserving the vascular arcade. B: The coloplasty pulled through to the proposed anal site as a definitive procedure. 2. SECOND STAGE B. Laparotomy Tubularization Of The Colon. 2. SECOND STAGE B.
Laparotomy Tubularization Of The Pouch Colon. 2. SECOND STAGE B. Laparotomy Pull Through Of The Tubularized Colon 2. SECOND STAGE: A. POSTERIOR SAGITAL APPROUCH B. LAPAROTOMY ——-C. BACK TO POSTERIOR SAGITAL INCISION 2. SECOND STAGE A. Posterior Sagital Approuch B. Laparotomy C. Back To Posterior Sagital Incision 2. SECOND STAGE A. Posterior Sagital Approuch B. Laparotomy I. Ligation Of The Fistula. II. Ligation Of The Blood Vesseles. III. Tubularization Of The Colon. C. Back To Posterior Sagital Incision Final Ano_ Recto Plasty.
Post operative follow up closure of the ileostomy: Signs and symptoms of intestinal obstruction . Laparotomy : stenotic segment just at the junction of the ileum, resection of this segment ileostomy. Closed 2 months later. Now he is 4 years old thriving well with partial incontinence and with out anal skin excoriation. RECOMMENDATION Invertogram done for anorectal malformations should be followed by erect abdominal x ray. Avoid long segment for tubulization. The utilization of a shorter segment of the pouch for tuboplasty is recommended.