Pregnancy in a case of co...

A 27 year old primigravida 37 weeks gestation, reported with latent labour with breech presentation. In 2001 patient was diagnosed with anorectal malformation after birth as there was no passage of meconium and abdominal distension was present. Invertogram was suggestive of intermediate anorectal malformation. In 2001 , High sigmoid colostomy was done and postoperatively colostomy was healthy and functioning up regularly. Patient was followed up regularly and in 2003 distal colonogram was done and there was no evidence of leak or fistula. In 2006; posterior sagittal anorectoplasty with neo anus creation with perineal body reconstruction was done. In 2021,anal spinchter reconstruction with gracilis muscle was performed ivo anorectal manometry suggestive of decreased resting anal tone and poor squeeze pressure which indicate that patient may develop fecal incontinence.

Patient became pregnant eventually on 2022 with colostomy bag in situ stoma care was followed. Pregnancy course was uneventful. Patient was referred to us at 28 weeks and evaluation was done. Patient was again admiited at 37 weeks for latent labour. Emergency lower segment Cesarean section was performed with breech presentation in labour with non reassuring intrapartum monitoring. During LSCS midline vertical incision was given and intraoperative course was uneventful. No bowl bladder adhesion was present. Abdominal wall was closed in layers and post operative course was uneventful.

Colostomy is usually carried out for benign diseases and it is uncommon to see those become pregnant. In a pregnant women as the fetus grows in uterus and women begins to gain weight, stoma may protude, diameter may increase, skin around stoma start to flatten out. Our patient felt no difference in pregnancy except dragging sensation in the area of colostomy. Nevertheless potential complications such as intestinal obstruction, stoma prolapse, narrowing of stoma and bleeding remain as source of reported complaints in women with colostomy.