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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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LETTER TO EDITOR
Year : 2017  |  Volume : 22  |  Issue : 3  |  Page : 191-192
 

Delayed presentation of congenital colonic stenosis


Department of Pediatric Surgery, G.M.K. Medical College, Salem, Tamil Nadu, India

Date of Web Publication8-Jun-2017

Correspondence Address:
Saravanan Natarajan
Department of Pediatric Surgery, G.M.K. Medical College, Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_232_16

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How to cite this article:
Natarajan S, Vijayshankar R, Periasamy M, Rangasamy S, Ramasamy R. Delayed presentation of congenital colonic stenosis. J Indian Assoc Pediatr Surg 2017;22:191-2

How to cite this URL:
Natarajan S, Vijayshankar R, Periasamy M, Rangasamy S, Ramasamy R. Delayed presentation of congenital colonic stenosis. J Indian Assoc Pediatr Surg [serial online] 2017 [cited 2019 Sep 20];22:191-2. Available from: http://www.jiaps.com/text.asp?2017/22/3/191/207637




Sir,

Congenital colonic stenosis (CCS) is a rare anomaly. It is a type of colonic atresia, and it usually presents itself during the newborn period. Delayed presentation is extremely rare.[1] Hereby, we report a 4-month-old infant with CCS, successfully managed by partial excision of the obstructing web.

A 4-month-old female infant was admitted with complaints of not having passed stools for 4 days and of abdominal distension, following a recent episode of febrile illness. The infant did not have any history of constipation. On examination, the infant was weighing 3.75 kg and had abdominal distension. On per rectal digital examination, the rectum was found empty. An X-ray of the chest and abdomen showed dilated bowel loops, and an ultrasonography of the abdomen reported gaseous distension of bowel loops. A barium enema done showed a narrow distal colon, and the barium was stopping short at the splenic flexure, with proximal dilated colon [Figure 1]a. A probable diagnosis of long segment Hirschsprung's disease was made, and surgery was planned. On exploration, the distal ileum, cecum, ascending colon, and proximal transverse colon were found dilated, and the distal transverse colon, descending colon, and sigmoid colon were found narrow. There was an abrupt change in the size at mid-transverse colon, with the proximal colon approximately three times more dilated than the distal transverse colon [Figure 1]b. On the table, a colonic atresia was suspected and a longitudinal incision of about 4 cm was made over the antimesenteric border of the mid transverse colon. There was a thick intraluminal membrane (web) with the central hole, which produced stenosis of the lumen [Figure 1]c. The posterior half of the membrane was excised and the mucosa was approximated. The longitudinal incision was closed transversely, similar to pyloroplasty. The infant was treated with usual postoperative care, and she made an uneventful recovery. The histopathology of the excised specimen confirmed the presence of ganglion cells, along with nonspecific inflammation of the colonic mucosa. The infant is on follow-up for the past 4 months, without any specific complaints.
Figure 1: (a) Barium enema; (b) Dilated proximal, narrow distal transverse colon; (c) Thick intra-luminal membrane

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CCS, a type of colonic atresia, is a rare entity. Only 1.8–15% of the intestinal atresias occur in the colon. CCS is even less common than colonic atresia and only 16 cases have been reported since 1968.[1] Colonic stenosis can be of acquired etiology, usually after a bout of necrotizing enterocolitis.[2] Most commonly accepted theory for developing intestinal atresia and stenosis is based on mesenteric vascular accidents occurring during fetal development.[3] Depending on the severity of ischemia, stenosis or atresia may occur. This type of vascular accident is the most probable cause for the stenosis in our case. Of the reported cases, CCS has been noted in the descending colon in five cases, sigmoid colon in four cases, ascending colon in three cases, rectosigmoid in one case, and location of the stenosis was not mentioned in three cases.[4] CCS is usually diagnosed in the newborn period itself as it presents like any other intestinal obstruction. Surgical management varies from resection and primary anastomosis to diverting colostomy, followed by delayed anastomosis. Usually, atresia proximal to the splenic flexure is primarily anastomosed and those that are distal to the splenic flexure are diverted for delayed closure. In our case, the obstructing membrane was excised through a longitudinal incision and coloplasty was done by closing the colon transversely, with a satisfactory outcome.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ruggeri G, Libri M, Gargano T, Pavia S, Pasini L, Tani G, et al. Congenital colonic stenosis: a case of late-onset. Pediatr Med Chir 2009;31:130-3.  Back to cited text no. 1
    
2.
Mirza B, Iqbal S, Ijaz L. Colonic atresia and stenosis: Our experience. J Neonatal Surg 2012;1:4.  Back to cited text no. 2
    
3.
Louw JH. Investigations into the etiology of congenital atresia of the colon. Dis Colon Rectum 1964;7:471-8.  Back to cited text no. 3
    
4.
Zambaiti E, Chiaramonte C, Salerno S, Li Voti G, Siracusa F. Corrigendum to “multiple congenital colonic stenosis: A rare gastrointestinal malformation”. Case Rep Pediatr 2016;2016:5353012.  Back to cited text no. 4
    


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