Acquired Microcolon after 20 Years of Colostomy: Can it be Saved?
2021
Objectives: To report a case of a stoma reversal in a patient with an acquired, extreme microcolon after a
long-standing transversostomy and to give a review of the current literature.
Methods: Case report and literature review by performing a PubMed database search, using the keywords
Santulli enterostomy, anal atresia, posterior sagittal anorectoplasty and acquired microcolon.
Results: An 18-year-old patient with a previous history of anal, rectal and sigmoid atresia, was admitted to
our hospital with an acquired microcolon due to a long-standing transversostomy. The patient had a posterior
sagittal anorectoplasty at the age of one year, but by reason of an enormous dilatation of the ascending colon
and the associated discrepancy of the caliber of the proximal and distal colon, the colostomy was maintained.
The patient was lost in follow-up during several years. Now, 16 years later, the patient requested closure of
the colostomy. Since barium enemas still showed a dilated colon ascendens and a microcolon descendens,
a staged approach was chosen. First, a right hemicolectomy was performed and a Santulli enterostomy was
created by constructing an ileocolostomy just proximal of an end ileostomy. Progressively, more transanal
bowel movements were seen and barium enemas showed a progressive expansion of the remaining colon
and rectum. Test closing of the enterostomy using an inflated bladder catheter did not cause signs of
obstruction. During the second stage, 17 months later, at the age of 20 years, the stoma was closed. Now,
the patient has two to three solid stools a day, with a complete fecal continence.
Discussion: The used technique is well known in pediatric surgery. We successfully implemented it in the
treatment of a microcolon in an adult. The advantage is that we can feed the distal colon to achieve
expansion, while the enterostomy functions as a venting system, hereby preventing obstructive complaints
when the caliber of the colon is still narrow. In conclusion, long-standing colostomas with a concurrent
microcolon can be closed but require a step-by-step approach.
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