Use of congenital pouch colon for augmenting the neurogenic bladder in a child: a 13-year follow-up

Abstract

Congenital pouch colon is an anomaly always associated with anorectal malformation, where the colon is replaced by or terminates into a large aperistaltic intestinal pouch. Vertebral anomalies leading to neurogenic bladder are rare associated malformations. The pouch is aperistaltic and thus a poor rectal substitute but this very property makes it ideal for bladder augmentation. We report the first case where the pouch has been used to augment a high-pressure neurogenic bladder.

Figure 1

A distal colonogram showing the pouch colon with a faecaloma inside (curved white arrow on left side) and subsequent filling up of the bladder (broad white arrow on right side).

Figure 2

(a) Schematic diagram of intraoperative findings showing a baggy pouch colon (P) at terminal end of colon situated just behind the urinary bladder (B). A fistula (F) connecting the pouch colon with bladder neck shown by arrow. (b) Schematic diagram of procedures undertaken in operation: the fistula connecting the pouch (P) with the bladder neck was disconnected. The normal colon (C) proximal to the pouch was divided just above the pouch and brought down as the neorectum. The anterior wall of the pouch and the posterosuperior wall of the bladder (B) were opened longitudinally and a wide bladder to pouch anastomosis was performed thus completing the augmentation. The right ureter was transected at its lower third and a right-to-left transureteroureterostomy was performed. The refluxing distal stump of the right ureter was placed in a submucosal channel extravesically and its upper end brought out to the skin to form a catheterisable channel (M).

Figure 3

Cystourethrogram of augmented bladder.