Case Summary
Dr. Mikhail Gopienko from St. Petersburg, Russia, presented a case of a neonatal surgery involving a boy with an absent anus. The boy was admitted to the hospital at 4 hours old, and during the following 24 hours, there was an increase in abdominal distension.
Congenital Pouch Colon and Fistula
Dr. Gopienko discussed the possibility of a congenital pouch colon. The patient was found to have sigmoid atresia and two segments of blind-ending rectum. The patient underwent a double-barrel colostomy and later an Anderson procedure on the right side. Dr. Gopienko raised questions about the presence of a possible fistula, the interpretation of the cystoscopy data, and the possibility of a more complex malformation. He also questioned whether it would make sense to repeat the cystoscopy during the anorectal repair.
Complex Case and Surgical Considerations
Dr. Peña suggested a thorough pelvic MRI to clarify the anatomy and to assess the blood supply to the rectum. He recommended attempting a pull through with the distal rectum as an anoplasty, but warned of potential complications, such as abnormal blood supply or insufficient length. Dr. Peña also emphasized the importance of addressing the baby's renal function issues first, as they were deemed a more urgent matter. The possibility of needing an additional stoma was also discussed, and Dr. Peña suggested the need for flexibility in the operating room to accommodate various scenarios.
Patient Case Discussion