LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 2 | Page : 101
Type V congenital pouch colon: A need to expand the scope of the definition
Rajiv Chadha, Shinde Nand Kishore, Subhasis Roy Choudhury
Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
|Date of Web Publication||17-Feb-2015|
Dr. Rajiv Chadha
G-123, Vikaspuri, New Delhi - 110 018
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chadha R, Kishore SN, Choudhury SR. Type V congenital pouch colon: A need to expand the scope of the definition. J Indian Assoc Pediatr Surg 2015;20:101
|How to cite this URL:|
Chadha R, Kishore SN, Choudhury SR. Type V congenital pouch colon: A need to expand the scope of the definition. J Indian Assoc Pediatr Surg [serial online] 2015 [cited 2023 Feb 2];20:101. Available from: https://www.jiaps.com/text.asp?2015/20/2/101/151565
The most widely accepted classification of congenital pouch colon (CPC), described by Narasimharao et al.,  classifies the condition into four subtypes based on the length of normal colon proximal to the colonic pouch. Subsequently, in 2008, Saxena and Mathur  added another subtype, Type V CPC, described as "double pouch colon with short normal interposed colon segment" in which a proximal segmental dilatation of the colon (SDC) communicates distally via a short segment of normal colon with a colonic pouch terminating in a fistula with the genitourinary tract. A review of the literature, however, shows that only three cases of Type V CPC, as described by these authors, have been reported in the literature, while in nine reported cases, CPC was associated with prune-belly syndrome (PBS), in four cases with rectal atresia, and in two cases with pseudoexstrophy.
Other described variants of CPC include a report of a boy with imperforate anus in whom the ascending, transverse, and descending colon were replaced by a colonic pouch while the distal sigmoid colon was normal in caliber and ended deep down in the pelvis.  The authors suggested that this variant should be called Type V "pouch colon syndrome".  Puri et al.  described two boys with CPC in one of whom a Type III CPC was associated with a colovesical fistula whereas in the other child, a 6-cm length of normal colon opened into a pouch-like dilatation of the ascending and transverse colon, followed by a length of normal colon ending in a rectourethral fistula. In both patients, there was a Y-shaped duplication of the normal colon just proximal to the dilated colonic segment.  There is also a report of CPC associated with an ileovesical and a colovesical fistula, and another report in which CPC was associated with double colovesical fistulae.
It is of interest that at a consensus meet on management of CPC held in New Delhi in 2007, it was suggested that the original Narasimharao et al. classification  should be modified with the addition of Type V CPC, which would include CPC associated with segmental colonic dilatation or CPC with rectal atresia, or other variants.  Considering that several different variants of CPC have been reported, it is suggested that the definition of Type V CPC should be expanded to include all the uncommon variants of CPC such as CPC associated with SDC, CPC associated with PBS, CPC associated with rectal atresia, and other more rare variants.
| References|| |
Narasimharao KL, Yadav K, Mitra SK, Pathak IC. Congenital short colon with imperforate anus [pouch colon syndrome]. Ann Pediatr Surg 1984;1:159-67.
Saxena AK, Mathur P. Classification of congenital pouch colon based on anatomic morphology. Int J Colorectal Dis 2008;23:635-9.
Mahajan JK, Mohanan A, Rao KL. Pouch colon syndrome-hitherto undescribed variant. J Indian Assoc Pediatr Surg 2005;1 Suppl 1:S35. [Abstract A: 51].
Puri A, Choudhury SR, Yadav PS, Grover JK, Pant N, Chadha R. Congenital pouch colon and segmental dilatation of the colon: A report of two unusual cases. J Indian Assoc Pediatr Surg 2011;16:61-3.
Bhatnagar V, Sarin YK, Chadha R, Wakhlu A. Proceedings of Consensus Meeting on Management of Congenital Pouch Colon under Aegis of IAPS, 12 th
March 2007, New Delhi, India.