TY - JOUR
AR - SCR-2021-8-111
TI - Acquired Microcolon after 20 Years of Colostomy: Can it be Saved?
AU - Liesbeth van , Bergen
AU - Simon, Nicolay
AU - Martin, Ruppert
AU - Anthony, Beunis
AU - Sylvie Van den, Broeck
AU - Niels, Komen
JO - Surgical Case Reports
PY - 2021
DA - Mon 30, Aug 2021
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2021.08.11
UR - https://www.sciencerepository.org/acquired-microcolon-after-20-years-of-colostomy_SCR-2021-8-111 
KW - Santulli enterostomy, Peña operation, anal atresia, posterior sagittal anorectoplasty, acquired microcolon
AB - 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.