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Intestinal stoma complications in immunocompromised children
S Rokhsar1, E A Harrison, D B Shaul
1Division of Pediatric Surgery, Childrens Hospital Los Angeles and the University of Southern California School of Medicine, 90027, USA.
Insights
Creating intestinal stomas in immunocompromised children, while associated with morbidity, does not negatively impact their survival. These children often succumb to their underlying conditions rather than stoma-related complications.
Area of Science:
- Pediatric Surgery
- Immunocompromised Patients
- Gastrointestinal Surgery
Background:
- Immunocompromised children undergoing urgent gastrointestinal surgery face a dilemma: intestinal anastomosis carries risks of leakage and sepsis, while intestinal stoma creation is an alternative.
- The decision-making process for these high-risk patients necessitates understanding the outcomes associated with stoma creation.
Purpose of the Study:
- To evaluate the postoperative course of immunocompromised children treated with intestinal stomas.
- To assess the long-term survival rates of pediatric patients who have undergone intestinal stoma creation.
Main Methods:
- A 13-year retrospective review was conducted.
- Data collected included patient diagnosis, surgical indication, stoma type, postoperative complications within 30 days, ostomy-related complications, and survival status.
Main Results:
- 19 stomas were created in 18 immunocompromised children (6 with immunodeficiency, 12 with chemotherapy-induced immunosuppression).
- Postoperative complications occurred in 68% of patients, and stoma complications in 32%.
- Despite significant morbidity, 50% of patients survived, with no deaths directly attributed to stoma complications.
Conclusions:
- Immunocompromised children requiring intestinal stomas face high mortality due to underlying diseases.
- While stomas can cause morbidity, their creation does not appear to compromise overall patient survival.
- Stoma takedown was possible in a majority of survivors.
Background/Purpose:
When performing an urgent gastrointestinal operation on an immunocompromised child, the pediatric surgeon may have to decide between performing an intestinal anastomosis (and risk leakage or sepsis) or creating an intestinal stoma. This study evaluates the postoperative course of those patients treated with intestinal stomas and the long-term survival rate of such patients.
Methods:
A 13-year retrospective review of immunocompromised children with intestinal stomas was performed. Patients were assessed as to their diagnosis, indication for surgery, stoma type, postoperative complications (within 30 days of surgery), ostomy-related complications, and survival.
Results:
19 stomas (8 ileostomies and 11 colostomies) were created in 18 patients. Six children had immunodeficiency disorders; 12 were immunosuppressed from chemotherapy treatment for cancer. Indications for surgery included infectious complications (n = 8); neoplasm-induced bowel obstruction, perforation, or invasion (n = 10); and Hirschsprung's disease (n = 1). Postoperative complications occurred in 13 cases (68%); two warranted reoperation. Four of six patients with neutropenia had serious postoperative infectious complications. Stoma complications occurred in 6 cases (32%); 1 required revision. All 3 patients in whom bleeding developed from their stoma site were thrombocytopenic. Nine of 18 patients (50%) died, yet no patient died of complications attributable to their stomas. Of the surviving 9 children, 6 underwent stoma takedown at a mean of 19 months after creation; 1 has a permanent colostomy, and 2 currently are undergoing chemotherapy.
Conclusion:
Although immunocompromised children who require intestinal stomas frequently die of their underlying illnesses and their stomas often produce considerable morbidity, stoma creation does not jeopardize their chance of survival.