Estenosis congénita de colon con retención de cuerpos extraños: informe de un caso / Congenital stenosis of the colon with foreign bodies: case report

Introducción: La estenosis del colon es rara, con una incidencia de uno entre 40 mil nacimientos. El colon ascendente y transverso son los más afectados. Las manifestaciones clínicas pueden aparecer desde el nacimiento. Caso clínico: Niño de dos años 11 meses de edad, con cuadros periódicos de estreñimiento, dolor tipo cólico y distensión abdominal. La radiografía simple de abdomen mostró dilatación de asas y cuerpos extraños. El colon por enema fue normal. Por laparotomía exploradora se identificó estenosis en el colon transverso. Se practicó resección, extracción de cuerpos extraños y anastomosis término-terminal. El examen histopatológico mostró estenosis con lumen de 0.5 cm; las células ganglionares estuvieron presentes entre las capas musculares. A dos años de la cirugía, el paciente se encontraba asintomático. Conclusiones: La estenosis congénita de colon es poco frecuente. Abdu-Judeh informa un caso y refiere ocho descritos desde 1941. Las manifestaciones clínicas son estreñimiento, vómito y distensión abdominal, sin embargo, los pacientes pueden permanecer asintomáticos por periodos variables, lo que dificulta y retrasa el diagnóstico. No existe informe previo acerca de la retención de cuerpos extraños. El colon por enema y la colonoscopia son necesarios para el diagnóstico oportuno. El tratamiento electivo es la resección quirúrgica con anastomosis primaria o colostomía; una opción es la cirugía laparoscópica.

BACKGROUND: Colonic stenosis is rarely seen in pediatric practice. Its incidence has been reported as 1/40,000 births. Ascending and transverse colon are the most common sites affected. Symptoms may be present at birth. CLINICAL CASE: We present the case of a 2 year, 11 month old male. Since birth, the patient had symptoms of constipation, abdominal pain and abdominal distension. X-ray of the abdomen showed a dilated colon and foreign bodies on the right side. Barium enema was normal. The stenotic segment was resected. Foreign bodies were removed and alimentary continuity was restored by end-to-end anastomosis. The pathologist found a 5-cm lumen at the stenosis. Histological ganglion cells were present throughout the specimen. The patient evolved favorably postoperatively and was discharged 1 week after surgery. The patient has been in good health for 2 years. CONCLUSIONS: Colonic stenosis is uncommon. Abu-Judeh reported on one case and a review of the literature revealed eight cases of congenital colonic stenosis since 1941. Symptoms are abdominal distension, vomiting and constipation with symptom remission, making diagnosis difficult. This is the first report involving foreign bodies. Barium enema and colonoscopy are necessary for diagnosis. Resection of the stenotic segment with end-to-end anastomosis or colostomy is the treatment of choice. Laparoscopy is an alternative procedure.

Congenital pouch colon from Al Ahsa region of Saudi Arabia - A changing demography?

To study the demography, anatomy and management of congenital pouch colon [CPC] in the Al -Ahsa region of the Kingdom of Saudi Arabia [KSA]. Retrospective descriptive analysis of CPCs was made with regard to patient demography, pre- and intra-operative diagnostic features and initial neonatal management. Maternity and Children Hospital, Al-Ahsa region, KSA. Records of all children with anorectal malformations [ARM] treated between August 2004 and August 2007 were reviewed. Out of the 37cases of ARMs, seven were diagnosed as CPCs. Records were analysed for perineal findings, X-ray abdomen and invertogram [when indicated], abdominal ultrasound, type of pouch, division of any urinary fistula, and surgical management. Six out of seven CPCs were among Saudi nationals belonging to Al-Ahsa region. The male to female ratio was 4:3. Six were type IV and one was type III pouch. Preoperative diagnoses were made in two cases by radiology and all cases showed classic anatomical features of CPC intra-operatively. 71% had associated anomalies. Excision of pouch and end colostomy was done in three, loop stoma was done in two and excision of pouch with neonatal pull-through was done in two cases. CPCs are recently being increasingly reported in Saudi nationals. Adequate awareness about radiological, anatomical and histological features would lead to correct diagnosis and reporting. Appropriate neonatal management would prevent pouch related morbidity. Collective data from multiple centers across the Arab peninsula will help define the demographic pattern of this entity in the region

Congenital pouch colon with imperforate anus; a report of 3 cases

Congenital pouch colon [CPC] is an unusal condition in imperforate anus [IA] usually of high variety this malfotmation is mostly reported from India, where it comprises about 7% of all anorectal malformations. In this anomaly the normal colon is very short or absent and is replaced by a pouch like dilatation that usually communicates through a fistula with genitourinary tract or persistent cloaca. We are reporting on three cases of newborns [2 females, and 1 male] with this anomaly diagnosed during September 2001 to September 2004 These three cases comprise less than 3% of all cases of IA during this time period. The two girls had anorectal agenesia, short segment of colon and a pouch with vaginal fistula and persistent cloaca [Type II]. Colon in the third case was replaced by a dilated pouch that communicated with a wide fistula to the bladder [Type I]. This is very important for pediatric surgeons to be aware of the features of this condition to allow for proper diagnosis and surgical management

Congenital ceco-vesical fistula associated with anorectal malformation: Case report

Congenital ceco-vesical fistula [CCVF] associated with high anorectal malformation was not described before. The only described case in 1972 was associated with total colonic atresia which are not the case. We report a case of CCVF associated with a blind ended distal colon in a 50-day old male presented with high imperforate anus faecalurea, and epididymo -orchitis of the left testis. The bladder was separated from the cecum followed by abdomino-perineal pull-through of the colon. The relevant literature is reviewed, and the diagnostic modalities and management are discussed

Congenital segmental dilatation of colon with colonic atresia.

Congenital segmental dilatation of the colon belongs to a group of Hirschsprung's-like diseases with normal ganglion cells. The presentation is with chronic constipation affecting older children. We report a neonate with congenital segmental dilatation of the colon associated with sigmoid atresia. The child is well after a colostomy.