A Case of Congenital
Colonic Stenosis
Presenting
By Ganesh K. Pai and Pushpalatha Mangalore.
as Rectal Prolapse
K. Pai
India
l A case of colonic stenosis at the rectosigmoid junction in a 4-month-old girl presented as prolapsed rectum and was diagnosed with the help of a plain x-ray and a barium enema. The clinical presentation and surgical management are detailed. 0 1990 by W.B. Saunders INDEX WORDS:
Company.
Colonic stenosis; prolapse of rectum.
0
NE OF THE RARE causes of obstruction of the colon during the neonatal period is colonic atresia. Morson et al’ state that “Atresias and stenosis are extremely rare in the caecum and colon.” According to Halles2 mechanical injury to the vascular system of the bowel is probably the pathogenetic agent. This may result from intrauterine intussusception, isolated volvuhis, or incarceration. CASE REPORT
A 4-month-old girl developed a prolapsed rectum following diarrhea. The child was taken to a local hospital and was treated by circumanal suturing. On the 8th postoperative day the baby developed constipation and abdominal distention. One month following the surgery the child was referred to our department. On examination the child had gross abdominal distention with mild visible intestinal peristalsis. Rectal examination did not show any evidence
Fig 2. pouch.
Barium enema. Lateral view with dye in the anorectal
of anal stenosis or remnant of circumanal suture. Plain x-ray of the abdomen showed multiple dilated loops with air fluid levels (Fig 1). The barium enema demonstrated filling of the anorectal pouch with barium. No contrast media could be visualised in the sigmoid colon (Fig 2). A provisional diagnosis of congenital partial obstruction at the rectosigmoid junction was made. Laparotomy showed a dilated loop of sigmoid and collapsed rectum without any surface discontinuity. Sigmoid colotomy demonstrated a septum at the rectosigmoid junction with an central perforation measuring 2 mm in diameter (Fig 3). Resection and end-to-end anastomosis were performed and the child made an uneventful postoperative recovery. DISCUSSION
The classification of small bowel atresias first described by Sutton3 has been applied to colonic atresia. A type 1 lesion exhibits external continuity with an intraluminal diaphragm that may be imperforate (atresia) or perforate (stenosis-rare). It is quite evident
Fig 1. Plain x-ray of the abdomen in erect posture shows air fluid levels.
Journal of Pediatric Surwry, Vol 25. No 6 tJuna), 1990:
pp 699-700
From the Departments of Pediatric Surgery and Pathology, Kasturba Medical College. Mangalore. India. Address reprint requests to Dr. Ganesh K. Pai, MS, MCh, Pediatric Surgeon, Hemavathy Building, Balmatta, Mangalore 575 001, India. 6 1990 by W.B. Saunders Company. OOZZ-3468/90/2506-0032$03.00/0
699
700
PAI AND PAI
the upper third of the rectum in a lo-year-old boy. Benson et al6 reported 22 cases of colonic atresia and stenosis. In their series only one stenosis was located in the sigmoid colon. Possibly, the child strained to pass stools, and caused prolapse of the rectum. Episodes of diarrhea most likely were due to enterocolitis proximal to the site of obstruction. Both these factors must have contributed to the mucosal prolapse of the rectum. REFERENCES
Fig 3. Schematic diagram of the pathological anatomy with the resected specimen with probe in situ.
that this case comes under type l-colonic stenosis. Peck et al4 reviewed 36 cases of successfully treated congenital atresia of the colon in the newborn and found only one case of stenosis occuring in the region of the sigmoid colon. Cole’ reported congenital stenosis at
1. Morson BC, Dawson IMP, Spriggs AI, et al: Gastro Intestinal Pathology (ed 2). New York, NY, Blackwell, 1979, p 496 2. Halles JA Jr: Atresia of the small intestine, current concepts in diagnosis and treatment. Clin Pediatr 3:257-262, 1964 3. Sutton JB, cited by Philippart AI: Atresia, stenosis and other obstructions of the colon, in Welch KJ, Randolph JG, Ravitch MM, et al (Eds): Pediatric Surgery, ~012. Chicago, IL, Year Book, 1986, p 984 4. Peck DA, Lynn HB, Harris LE: Congenital atresia and stenosis of the colon. Arch Surg 87:428-439, 1963 5. Cole GJ: Congenital diaphragm in the upper rectum. Br J Surg 50523-524, 1963 6. Benson CD, Lotfi MW, Brough AJ: Congenital atresia and stenosis of the colon. J Pediatr Surg 3:253-257, 1968
Colonic Stenosis
Presenting
By Ganesh K. Pai and Pushpalatha Mangalore.
as Rectal Prolapse
K. Pai
India
l A case of colonic stenosis at the rectosigmoid junction in a 4-month-old girl presented as prolapsed rectum and was diagnosed with the help of a plain x-ray and a barium enema. The clinical presentation and surgical management are detailed. 0 1990 by W.B. Saunders INDEX WORDS:
Company.
Colonic stenosis; prolapse of rectum.
0
NE OF THE RARE causes of obstruction of the colon during the neonatal period is colonic atresia. Morson et al’ state that “Atresias and stenosis are extremely rare in the caecum and colon.” According to Halles2 mechanical injury to the vascular system of the bowel is probably the pathogenetic agent. This may result from intrauterine intussusception, isolated volvuhis, or incarceration. CASE REPORT
A 4-month-old girl developed a prolapsed rectum following diarrhea. The child was taken to a local hospital and was treated by circumanal suturing. On the 8th postoperative day the baby developed constipation and abdominal distention. One month following the surgery the child was referred to our department. On examination the child had gross abdominal distention with mild visible intestinal peristalsis. Rectal examination did not show any evidence
Fig 2. pouch.
Barium enema. Lateral view with dye in the anorectal
of anal stenosis or remnant of circumanal suture. Plain x-ray of the abdomen showed multiple dilated loops with air fluid levels (Fig 1). The barium enema demonstrated filling of the anorectal pouch with barium. No contrast media could be visualised in the sigmoid colon (Fig 2). A provisional diagnosis of congenital partial obstruction at the rectosigmoid junction was made. Laparotomy showed a dilated loop of sigmoid and collapsed rectum without any surface discontinuity. Sigmoid colotomy demonstrated a septum at the rectosigmoid junction with an central perforation measuring 2 mm in diameter (Fig 3). Resection and end-to-end anastomosis were performed and the child made an uneventful postoperative recovery. DISCUSSION
The classification of small bowel atresias first described by Sutton3 has been applied to colonic atresia. A type 1 lesion exhibits external continuity with an intraluminal diaphragm that may be imperforate (atresia) or perforate (stenosis-rare). It is quite evident
Fig 1. Plain x-ray of the abdomen in erect posture shows air fluid levels.
Journal of Pediatric Surwry, Vol 25. No 6 tJuna), 1990:
pp 699-700
From the Departments of Pediatric Surgery and Pathology, Kasturba Medical College. Mangalore. India. Address reprint requests to Dr. Ganesh K. Pai, MS, MCh, Pediatric Surgeon, Hemavathy Building, Balmatta, Mangalore 575 001, India. 6 1990 by W.B. Saunders Company. OOZZ-3468/90/2506-0032$03.00/0
699
700
PAI AND PAI
the upper third of the rectum in a lo-year-old boy. Benson et al6 reported 22 cases of colonic atresia and stenosis. In their series only one stenosis was located in the sigmoid colon. Possibly, the child strained to pass stools, and caused prolapse of the rectum. Episodes of diarrhea most likely were due to enterocolitis proximal to the site of obstruction. Both these factors must have contributed to the mucosal prolapse of the rectum. REFERENCES
Fig 3. Schematic diagram of the pathological anatomy with the resected specimen with probe in situ.
that this case comes under type l-colonic stenosis. Peck et al4 reviewed 36 cases of successfully treated congenital atresia of the colon in the newborn and found only one case of stenosis occuring in the region of the sigmoid colon. Cole’ reported congenital stenosis at
1. Morson BC, Dawson IMP, Spriggs AI, et al: Gastro Intestinal Pathology (ed 2). New York, NY, Blackwell, 1979, p 496 2. Halles JA Jr: Atresia of the small intestine, current concepts in diagnosis and treatment. Clin Pediatr 3:257-262, 1964 3. Sutton JB, cited by Philippart AI: Atresia, stenosis and other obstructions of the colon, in Welch KJ, Randolph JG, Ravitch MM, et al (Eds): Pediatric Surgery, ~012. Chicago, IL, Year Book, 1986, p 984 4. Peck DA, Lynn HB, Harris LE: Congenital atresia and stenosis of the colon. Arch Surg 87:428-439, 1963 5. Cole GJ: Congenital diaphragm in the upper rectum. Br J Surg 50523-524, 1963 6. Benson CD, Lotfi MW, Brough AJ: Congenital atresia and stenosis of the colon. J Pediatr Surg 3:253-257, 1968
