Congenital Pouch Colon in a Female Child of African Descent: A Case Report

Introduction and importance: Congenital pouch colon (CPC) is a rare anorectal malformation characterized by replacement of the colon with a dilated pouch and a genitourinary fistula. We report the first documented case in an African female child. Case presentation: A 5-year-old girl presented with lifelong abdominal distension, fecal soiling, and urinary incontinence, worse at night. Examination showed a distended abdomen, absent anal opening, and three vestibular openings. Cystogenitoscopy revealed two vaginal openings, a rectal fistula near the vaginal septum, and a wide hypospadiac urethra. Surgical exploration identified Type II congenital pouch colon with only 8 cm of proximal normal colon terminating in the upper vagina via a wide fistula. The pouch was excised with end colostomy, followed by definitive abdominoperineal pull-through three months later. Recovery was uneventful. Conclusion: Congenital pouch colon should be considered a rare but important cause of abdominal distension in patients with anorectal malformations, even within the African population. Careful perineal examination with gentle labial retraction, along with recognition of characteristic abdominal X-ray findings, can aid in preoperative diagnosis