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Congenital Pouch Colon in Girls: An Algorithm for Preoperative Diagnosis
Amit Gupta1, Amit Kumar1, Rajiv Chadha1
1Department of Pediatric Surgery, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India.
Insights
Congenital pouch colon (CPC) diagnosis in girls relies on specific clinical and radiological signs. Plain abdominal X-rays are 100% accurate for diagnosing this anorectal malformation.
Area of Science:
- Pediatric Surgery
- Radiology
- Anorectal Malformations
Background:
- Congenital pouch colon (CPC) is an uncommon anorectal malformation in girls.
- Accurate preoperative diagnosis is crucial for effective management.
Purpose of the Study:
- To define the preoperative diagnostic clinical and radiological features of congenital pouch colon (CPC) in girls.
- To develop an algorithm for the preoperative diagnosis of CPC.
Main Methods:
- Retrospective review of 47 girls with CPC managed between 1996 and 2018.
- Analysis of clinical and radiological features in two age groups: newborns to 12 months and >12 months to 20 years.
Main Results:
- Type II was the most common subtype (57.4%).
- Common features included abdominal distension, perineal excoriation, and urinary incontinence.
- Plain abdominal X-ray (AXR) and characteristic perineal appearance were 100% accurate for diagnosis.
Conclusions:
- Clinical examination findings should prompt suspicion of CPC.
- AXR is a mandatory and diagnostic tool for CPC.
- Further examination under anesthesia or endoscopy can confirm diagnosis if needed.
Aim:
The aim of the study was o define the preoperative diagnostic clinical and radiological features in girls with congenital pouch colon (CPC).
Materials And Methods:
Records of 47 girls with CPC, managed from 1996 to 2018, were reviewed. There were two age groups: Group A (newborn to 12 months; n = 26) and Group B (>12 months to 20 years; n = 21). The important clinical and radiologic features to help in a preoperative diagnosis were noted.
Results:
The most common subtype was Type II (57.4%), followed by Type I (23.4%) and Type III (12.8%). The features common to both the groups were abdominal distension (A = 53.8%; B = 9.52%), severe perineal excoriation (A = 19.2%; B = 23/8%), and urinary incontinence (A = 30.7%; B = 85.7%). In addition, in Group B, fecaloma on abdominal palpation was noted in 28.6% of patients. The characteristic appearance of the perineum including external genitalia and findings on plain abdominal X-ray (AXR) were 100% accurate and hence diagnostic. These unique features helped us formulate an algorithm for preoperative diagnosis of this uncommon form of anorectal malformation in girls seen in North India.
Conclusions:
The characteristic features on clinical examination should alert one to the presence of CPC in the outpatient clinic. The AXR was diagnostic in 100% of cases and is mandatory. If any doubt persists, examination of the genitalia under anesthesia with more retraction of the labial folds and endoscopy can be performed for confirmation. These measures should enable a clinician to make an accurate preoperative diagnosis in every girl with CPC.
