Case Report: A Congenital Pouch Colon with Anorectal Malformation and Associated Anomalies

Background: Congenital pouch colons (CPCs) are rare congenital malformations that are seen in the Indian Subcontinent and the surrounding region.These patients show major dilatations in one/more segments of the entire colon that are often associated with an anorectal malformation (ARM) and/or a fistulous communication with the distal urogenital tract.Many also show vesicoureteral reflux, hydronephrosis, hypospadias, a bicornuate/septate uterus, an absent/double appendix, a Meckel's diverticulum, rectal atresia, sacral agenesis, and congenital heart defects.This case shows that timely identification and management of CPCs can improve the outcome of these patients. Case presentation:We recently treated a four-day-old full-term, small-for-gestation female infant weighing 2.3 kg, who was presented with vomiting, abdominal distension, and had been passing stools through a single cloacal opening.An erect radiogram showed a massive colonic gas shadow on the left side that displaced the whole small bowel towards the right.An inverted X-ray showed a high anorectal malformation.Cystoscopy showed a constricted neck of the bladder and a bicornuate uterus.Hysteroscopy, and then an exploratory laparotomy confirmed the presence of a uterocolonic fistula, a massivelydilated pouch colon, a double appendix, and a Meckel's diverticulum.The fistula was ligated, and a pouch ostomy was done.A review of the case showed that she had a type-2 CPC with cloaca, a colon-uterine fistula, a bicornuate uterus, double appendix, and a Meckel's diverticulum.The infant stabilized over the next few days and was discharged from the hospital.She is being followed up and is progressing well.Conclusion: Congenital pouch colons are complex congenital anomalies that can benefit from early identification and proper management.The condition is seen more frequently in males and is promptly diagnosed during the neonatal period due to abdominal distention, absence of anus, and intestinal obstruction.It is managed surgically depending on its type, with timely diagnosis and management.Congenital pouch colon is a rare but important condition where timely diagnosis and management can improve the outcome.