CONGENITAL POUCH COLON - a rare type high anorectal malformation

POUCH COLON - Is a congenital condition in which all or part of colon is replaced by a pouch like dilated colonic  structure that communicate distally with urogenital tract through a fistula .It is a rare high type anorectal malformation , with the size of pouch variable [ 5 to 15 cms ] . In this small bowel ( terminal ileum) opens into a blind pouch like colon . Rest of  colon , rectum , anal canal & anus are missing . There is usually associated fistula connecting pouch to Genitourinary system.

TYPES OF POUCH COLON

Type 1- Absent normal colon & the terminal ileum opens into colonic pouch

Type 2 - The ileum opens into short segment of cecum which then opens into pouch

Type 3 - A significant length of normal colon is present between ileum & pouch 

Type 4 - Near normal colon present with only part of colon [  rectum and sigmoid ] converted into a pouch

Below presented is rare type 1 pouch colon-

Clinicals- A day 2 neonate with distension abdomen & imperforate anus 

Fig1- Abdominal radiograph of a day 2 neonate shows a large gas shadow occupying more than half of abdominal diameter, is a distended pouch colon, in a case of imperforate anus . The radiographic finding is classical & sufficient to diagnose this anomaly ( pouch colon) . 

Fig2- Invertogram shows high type of ARM with a large gas shadow . Another gas shadow down to pouch is gas in the urinary bladder , s/o pouch vesical fistula .

Fig3- Peroperative photograph shows terminal ileum opening into pouch colon . A small rudimentary appendix is also seen attached to pouch colon . The pouch colon was deflated before delivery to exterior.

Fig4- fully delivered pouch colon with attached small appendix, and terminal ileum entering into it on right side . A fistula was also present connecting pouch to urinary bladder.

PS- The case study is intended for medical professionals for academic purposes. 

- I express my sincere thanks to Dr Gaurav Bahety , M.Ch ( ped surgery) , Bhilwara for sharing this case & operative feedback .