Localized absence of colonic musculature: an unusual cause of perforation in a colonic esophageal transplant.

A 4 1/2-year-old boy underwent subtotal esophageal substitution by left colon for caustic soda stricture. The transposed colon had to be removed for perforation 9 days later, and pathological examination showed several tiny perforations in an area 1.8 cm in diameter where the colonic wall was thin and devoid of muscularis. Arguments are presented to show that this absence of muscle coat is congenital. The perforations are thought to be the result of minimal ischemia in a colonic wall weakened by the defect.