Short colon variant.
MU Shenoy, MS Kulkarni, AD Bhagwat, VK Kapur
Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Parel, Bombay, India., India
M U Shenoy
Department of Pediatric Surgery, Bai Jerbai Wadia Hospital for Children, Parel, Bombay, India.
A one day old neonate with a short colon, associated exomphalos minor; bifid scrotum and ileovesical fistula is reported.
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Shenoy M U, Kulkarni M S, Bhagwat A D, Kapur V K. Short colon variant. J Postgrad Med 1995;41:107-107
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Shenoy M U, Kulkarni M S, Bhagwat A D, Kapur V K. Short colon variant. J Postgrad Med [serial online] 1995 [cited 2022 May 28 ];41:107-107
Available from: https://www.jpgmonline.com/text.asp?1995/41/4/107/511
Short Colon is rare in the western part of India. Only a few cases have been reported. We came across such a case, which had associated exomphalos minor bifid scrotum and ileovesical fistula.
A day one neonate weighing 1.65 kg was referred for the high variety of imperforate anus. The child was born of a full term normal vaginal delivery and had high imperforate anus. General examination showed an exomphalos minor with ruptured sac. He had coronal hypospadias with bifid scrotum and well descended testes besides the congenital talipes equino varus deformity of the foot. Invertogram showed a high imperforate anus but simultaneous plain X ray did not reveal any air fluid levels. The patient was subjected for exploratory laparotomy. On exploration we found that a loop of intestine had been accidentally ligated in the exomphalos sac while tying off the umbilical cord. The terminal ileum and proximal 3-4 cms of colon were nonviable. There was a large ileovesical fistula in the terminal ileum distal to the Meckel's diverticulum. The patient had double appendices and a normal caecum. The short colon was terminating into a blind pouch at the level of descending colon. The inferior mesenteric artery was absent and an arc from superior mesenteric artery and a leash of vessels coming from the retroperitoneum supplied the same. Resection and anastomosis of ileum and proximal part of ascending colon was performed. The ileovesical fistula was resected and the bladder was closed in two layers. Ileocolic anastomosis with primary pull through was performed. Postoperatively, initial recovery of the child was uneventful, but later succumbed to septicaemia 5 days after surgery in spite of receiving intensive care.
Interference in the longitudinal growth of the hindgut distal to allantois and failure of it's migration into pelvis in early embryonic life results in short colon,. By 5th week of intrauterine life the uro-rectal septum descends down and division of cloaca is complete by 9th week. Failure to complete the descent would result in persistence of fistula between hindgut derivative and genitourinary tract. Johnston and Koff have put forth an interesting explanation that the division of cloaca begins at the level of the allantois and proceeds downwards. The hindgut begins at the usual site of a Meckel's diverticulum and is greatly restricted in its length by its involvement in an exstrophy. They regard these cases as variants of vesicointestinal fissure in which the abdominal segments are skincovered. A large air fluid level occupying more than half the diameter of abdomen is diagnostic of short colon. In our case, this was not seen because of a large ileovesical fistula.
There is no case of short colon associated with any major abdominal wall defect reported yet in literature. In our case an exomphalos minor was found. An end colostomy with disconnection of fistula followed by coloplasty as second stage is proposed by some authors. These staged procedures are morbid and difficult because of involvement of a second stage in a colon already jeopardised of its length and blood supply. We carried out primary pull through in our case. This case is reported because of its association with exomphalos minor and an ileovesical fistula which is not reported previously.
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