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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.
Journal of Pediatric Surgery
|January 8, 2000
Summary
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.