Antenatal diagnosis of congenital pouch colon: a case report from the Indian subcontinent with insights into management

TL;DR

This case report describes the rare antenatal diagnosis of congenital pouch colon in a fetus, leading to timely treatment and a successful recovery.

Contribution

The paper presents a rare case of antenatal CPC diagnosis and highlights its impact on improved clinical outcomes.

Findings

CPC was suspected via ultrasound in the late third trimester due to a hypoechoic tubular lesion in the pre-sacral region.

Early diagnosis allowed for timely delivery and surgery, reducing complications and improving recovery.

The child underwent staged corrective surgeries and made a complete recovery.

Abstract

Congenital pouch colon (CPC) is highly uncommon congenital anorectal malformation where a distended pouch-like structure replaces either some part of the colon or the entire colon and communicates to the genitourinary tract through a fistula. Diagnosis of CPC is usually made after birth when neonate/infant presents with abdominal distension and absence of anal opening. Making antenatal diagnosis of CPC is difficult because of the lack of specific and verifiable signs on sonography. Hence, only a few cases of antenatal diagnosis of CPC have been reported.1,2 In our case, CPC was suspected on a routine antenatal growth scan ultrasound in the late third trimester, showing a hypoechoic tubular-shaped lesion in the pre-sacral region. With this suspicion, we suggested an institutional delivery at a tertiary level centre, and diagnosis of type III CPC was confirmed on post-delivery imaging and emergency primary surgery, done on the day 3 of life (pouch resection, division of fistula, and protective colostomy). The child also underwent further corrective surgeries in a staged manner in second year of life and recovered completely. Beforehand diagnosis prevented any unnecessary delay in operative care, reduced postoperative complications, and improved the overall outcome of this otherwise complex condition.

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