Two-staged management for all types of congenital pouch colon

Background: The aim of this study was to review our experience with two-staged management for all types of congenital pouch colon (CPC).Patients and Methods: This retrospective study included CPC cases that were managed with two-staged procedures in the Department of Paediatric Surgery, over a period of 12 years from 1 January 2000 to 31 December  2011.Results: CPC comprised of 13.71% (97 of 707) of all anorectal  malformations (ARM) and 28.19% (97 of 344) of high ARM. Eleven CPC cases (all males) were managed with two-staged procedures. Distribution of cases (Narsimha Rao et al.’s classifi cation) into types I, II, III, and IV were 1, 2, 6, and 2, respectively. Initial operative procedures performed were window colostomy (n = 6), colostomy proximal to pouch (n = 4), and ligation of colovesical fi stula and end colostomy (n = 1). As definitive procedures, pouch excision with abdomino-perineal pull through (APPT) ofcolon in eight, and pouch excision with APPT of ileum in three were  performed. The mean age at the time of definitive procedures was 15.6 months (ranges from 3 to 53 months) and the mean weight was 7.5 kg (ranges from 4 to 11 kg). Good fecal continence was observed in six and fair in two cases in follow-up periods, while three of our cases lost to follow up. There was no mortality following defi nitive procedures amongst above 11 cases.Conclusions: Two-staged procedures for all types of CPC can also be performed safely with good results. The most important fact that the defi nitive procedure is being done without protective stoma and therefore,it avoids stoma closure, stoma-related complications, related cost of stoma closure and hospital stay. Key words: Anorectal malformation, congenital pouchcolon, congenital short colon, staged procedure

Exploratory laparotomy for acute intestinal conditions in children: A review of 10 years of experience with 334 cases

Aim: The aim of this study was to review 10 years of experience in the management of children with acute intestinal conditions requiring exploratory laparotomy.Patients and Methods: This retrospective study included 334 children (244 boys and 90 girls) who underwent laparotomy for acute intestinal conditions between Jan 1, 2000 to Dec 31, 2009. Patients were grouped into two categories: group A (n = 44) included patients who needed laparotomy with terminal ileostomy and group B (n = 290) included patients who needed laparotomy without terminal ileostomy. Weexcluded neonates and patients with jejunoileal and colonic atresias, anorectal malformations, congenital pouch colon, neonatal necrotising enterocolitis, Hirschsprung’s disease, appendicitis, abdominaltrauma and gastrointestinal tumours.Results: During the last 10 years, 334 laparotomies were performed in children under 12 years: 59.88% for intestinal obstruction and 40.11% for perforation peritonitis. Causes in order of frequency were: ilealperforations 34.13%; intussusceptions 26.34%; Meckel’s obstruction 10.17%; congenital bands and malrotation 6.88%; postoperative adhesions 5.98%; miscellaneous peritonitis 5.68%; miscellaneousintestinal obstructions 4.79%; abdominal tuberculosis 4.19% and roundworm intestinal obstruction 1.79%. Ileostomy closures (n = 39) was tolerated well by all except one. The mortalities were 28 (8.38%) in groupB and 6 (1.79%) in group A. Conclusions: The need for re-exploration not only increases the morbidity but also increases mortality as well. Diverting temporary ileostomy adds little cumulative morbidity to the primary operation and is a safe option for diversion in selected cases. The best way to further reduce the mortality is to create ileostomy at first operation