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.