Congenital pouch colon

Case contributed by Dr Lorena Real Barajas

Presentation

Patient with no surgical history. Long-standing condition characterized by diarrheal evacuations, fecal incontinence, and discharge of fecal material from the vagina. It was treated for more than 15 years as probable Crohn disease.

Patient Data

Age: 45 years
Gender: Female

CT

CT

CT  with oral contrast which presents passage to the terminal ileum after this, the colonic pouch is identified. Apparent fistulous path between the vaginal cavity and the rectum.
Soft tissues without evidence of alterations suggesting previous surgical procedures.

Annotated image

Rectum and vagina with loss of fatty interface.

MRI

It was not possible to identify the colonic framework, topography replaced by a bag-shaped dilation, which communicates proximally with the ileum.
After administration of transrectal neutral contrast medium by foley catheter with passage of it towards the vaginal canal in relation to the fistulous tract, which has a diameter of 13 mm.

Case Discussion

 

Colonic congenital pouch is an anomaly which consists of total or partial absence of the colon, with replacement by a dilated structure, it can be associated with other alterations such as rectovesical, colovaginal or colovestibular fistulas. It is categorized into four subtypes according to the classification system described by Narsimha:

·        Type I: Normal colon is absent and the ileum opens directly into the colonic pouch

·        Type II: The ileum opens into a short segment of cecum which then opens into the pouch

·        Type III: Presence of a significant length of normal colon between the ileum and the colonic pouch

·        Type IV: Presence of near normal colon with only the terminal portion of colon (sigmoid and rectum) converted into a pouch.

In this case, the patient belonged to type I, likewise a fistula to the vaginal canal was associated.

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