Double Pouch Colon Revisited

A 3-day-old term male child weighing 2.1 Kg, born by spontaneous vaginal delivery, was admitted with complaints of abdominal distention, meconuria and absent anal opening. This was the first child of the couple who had a non-consanguineous marriage. On examination, there was abdominal distention, poorly developed gluteal folds and an absent anal opening. Plain X-ray abdomen showed two large air fluid levels (Fig. 1). At exploratory laparotomy, Saxena-Mathur classification type 5 congenital pouch colon (CPC) was found. Ileum was opening directly into a hugely distended pouch; there was no appendix. The pouch was dumbbell shaped with normal looking intervening colon of about 5 centimeters. The dumbbell shaped pouch (proximal and distal components) was opening into the bladder through a wide fistula. The proximal part of intervening colon was not communicating with the proximal pouch but was intimately adherent to it. However, the distal part of the intervening colon was communicating with the distal pouch. Both the dumbbell shaped pouch and the terminal colon were receiving blood supply from a prominent marginal vascular pattern (Fig. 2). The distal pouch and intervening normal-looking colon appeared dusky with doubtful viability, so it was excised. Tubularized proximal pouch was brought out as end colostomy. The histopathological examination revealed the disorganized muscles in the muscularis layer of pouch colon; the intervening colon had normal colonic histology though there was evidence of congestion. The child is awaiting definitive repair.