The colovesical fistula in congenital pouch colon: a histologic study.
OBJECTIVE
The aim of this study was to perform a detailed histopathologic examination of the terminal colonic pouch and the colovesical fistula (CVF) excised during surgical management of male patients with the more severe forms (types I/II) of congenital pouch colon (CPC) associated with anorectal agenesis.


METHODS
From January 2005 to December 2006, 25 male patients with types I/II CPC underwent abdominal exploration with dissection of the terminal portion of the colonic pouch and associated CVF till the bladder, division-ligation of the fistula, and excision of the colonic pouch. In 6 of the 25 patients, a complete dissection of the fistula to the bladder was possible, and in them, the terminal portion of the colonic pouch and the CVF were subjected to detailed histopathologic examination. The 6 patients included 3 newborns in whom this surgery was performed as a primary procedure, and 3 patients aged 3 months, 15 months, and 2 years, respectively, in whom a window colostomy of the pouch had earlier been performed. After due processing, multiple sections from the specimens were stained using the routine H&E method and examined under the microscope under different magnifications.


RESULTS
In 4 specimens, the epithelial lining of the CVF consisted of transitional stratified epithelium with underlying anal/urethral glands. In 2 specimens, obtained from patients 15 months and 2 years old, respectively, the lining was of nonkeratinizing, stratified squamous epithelium. Other findings included aganglionosis in the muscle layers (n = 2), submucosal and subserosal fibrosis (n = 1), and thickening of muscle layers in the fistulous portion, suggestive of the presence of an internal sphincter (n = 2).


CONCLUSIONS
The CVF in patients with types I/II CPC shows histologic features of the normal anorectal canal.
Chadha
Rajiv
R
Department of Pediatric Surgery, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India. rajiv_chadha_01@yahoo.com
Agarwal
Kiran
K
Choudhury
S Roy
SR
Debnath
Pinaki Ranjan
PR
D001003:Anal Canal / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D003106:Colon / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D005355:Fibrosis; D006627:Hirschsprung Disease / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007412:Intestinal Fistula / Q000151:congenital / Q000473:pathology* / Q000601:surgery; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008679:Metaplasia; D009130:Muscle, Smooth / Q000473:pathology; D012007:Rectum / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery; D001747:Urinary Bladder Fistula / Q000151:congenital / Q000473:pathology* / Q000601:surgery