© 2020, Leghari et al
Received Day: 07 Month: 07 Year: 2020
Accepted Day: 14 Month: 02 Year: 2021
J Pediatr Adolesc Surg. 2021; 1:124-126
DOI: 10.46831/jpas.v1i2.23
The Insufflated Baloon
Abdul Lateef LeghariI1 Medical College, Aga Khan University Hospital, Karachi
Muhammad Bilal MirzaI2 Department of Pediatric Surgery II, The Children’s Hospital and the Institute of Child Health, Lahore
Nabila TalatI2 Department of Pediatric Surgery II, The Children’s Hospital and the Institute of Child Health, Lahore
[corresp] Abdul Lateef Leghari, Medical College, Aga Khan University Hospital, Karachi E-mail: abdullateefleghari@gmail.com

A one-day-old neonate presents in emergency with abdominal distension and failure to pass meconium. On clinical examination, there is abdominal distension, and perineal examination reveals an imperforate anus. The child is irritable, but hemodynamically stable. X-ray abdomen (erect position) is performed (Fig. 1).

Questions
  1. What are the radiological findings in the radiograph above?
  2. In view of the above findings What is the most likely diagnosis and why?
  3. Which system of classification is preferred for your differential, and what is it based on?
Answers
  1. The radiograph shows an X ray Abdomen and Chest of a baby
    Cardiac size is normal.
    Bilateral lung fields are clear.
    Visualized bones appear normal.
    There is a large lucency on left side of abdomen with some soap bubble appearance. The other bowel loops appear prominent, dilated, and displaced to the right side of abdominal cavity.
  2. The overall appearances are secondary to a complete congenital pouch colon. Typical for a complete congenital pouch colon (CPC) is to have a large bowel loop (visualized as the large gas shadow) occupying more than 1/2 of the abdominal width on the Xray with displacement of the rest of bowel to the right hemi abdomen in a patient with anorectal malformation.[1], [2]
  3. Many classifications have been suggested for CPC, however the most widely used one was suggested by Narasimha Rao et al. on the basis of bowel length.[3] Type 1: Normal colon is absent, and the ileum opens directly into the colonic pouch (Fig. 2).
    Type 2: The ileum opens into a short segment of caecum, which then opens into the colonic pouch (Fig. 3).
    Type 3: Presence of a significant length of normal colon between the ileum and the colonic pouch (Fig. 4).
    Type 4: Presence of near-normal colon with only the terminal portion (rectum and sigmoid) converted into a pouch (Fig. 5).
    A simplified version of the same was later suggested where type I and II were categorized as “complete” and type III and IV as “incomplete” CPC.[4]
    Complete CPC may produce a big gas filled lucency on abdominal radiograph as shown in Figure 1. However, incomplete CPC produces a localized small lucency on abdominal radiographs.
Figures

Figure 1 

Xray abdomen and chest

Figure 2 

Type 1 CPC

Figure 3 

Type II CPC

Figure 4 

Type III CPC

Figure 5 

Type IV CPC
Notes

n1Conflicts of interest. None declared

n2Source of Support: Nil

n3Author contributions: Author(s) declared to fulfill authorship criteria as devised by ICMJE and approved the final version. Authorship declaration form, submitted by the author(s), is available with the editorial office.

n4Consent to Publication:Author(s) declared taking informed written consent for the publication of clinical photographs / material (if any used), from the legal guardian of the patient with an under­standing that every effort have been made to conceal the identity of the patient, however it cannot be guaranteed.

Acknowledgments

None

References
1. Wakhlu AK, Wakhlu A, Pandey A, Agarwal R, Tandon RK, Kureel SN. Congenital short colon. World J Surg. 1996;20(1):107–14
2. Chadha R, Khan NA. Congenital pouch colon. J Indian Assoc Pediatr Surg. 2017;22(2):69.
3. Narasimharao KL. Congenital short colon with imperforate anus (pouch colon syndrome). Ann Paediatr Surg. 1984;1:159–67.
4. Gupta DK, Sharma S. 11 Congenital Pouch Colon. Anorectal Malformations Child Embryol Diagnosis, Surg Treat Follow. 2006;211.