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Colostomy for anorectal anomalies: high incidence of complications
N Patwardhan1, E M Kiely, D P Drake
1Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, England, UK.
Insights
Colostomy formation for anorectal anomalies in newborns has a high complication rate, including prolapse and obstruction. Urinary tract infections occurred frequently but were not linked to colostomy type.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Gastrointestinal Surgery
Background:
- Anorectal anomalies are congenital malformations requiring surgical intervention.
- Colostomy formation is a common initial step in managing complex anorectal anomalies in neonates.
- Understanding colostomy-related complications is crucial for improving patient outcomes.
Purpose of the Study:
- To characterize the types and incidence of complications associated with colostomy formation in newborn infants with anorectal anomalies.
- To evaluate the impact of colostomy type on complication rates.
Main Methods:
- Retrospective review of a single institution's 5-year experience (1994-1999).
- Inclusion criteria: neonates with high/intermediate anorectal anomalies requiring colostomy at birth.
- Exclusion criteria: patients with colostomy still in place to maximize complication detection.
Main Results:
- 49 neonates with anorectal malformations were analyzed.
- Mechanical complications occurred in 32% of infants, including prolapse (50%), intestinal obstruction (44%), and skin dehiscence (19%).
- Urinary tract infections (UTIs) were observed in 29% of infants, with no significant difference between loop and divided colostomies.
Conclusions:
- Colostomy formation in neonates with anorectal anomalies is associated with a high incidence of complications.
- Mechanical complications and UTIs are significant concerns.
- The type of colostomy (loop vs. divided) did not influence the rate of UTIs.
Purpose:
The aim of this study was to characterize the type and incidence of complications related to colostomy formation in newborn infants with anorectal anomalies.
Methods:
The authors reviewed a 5-year (1994 to 1999) experience of a single institution in the management of neonates with high and intermediate anorectal anomalies who required colostomy at birth. Patients with colostomy still in place have been excluded from the study to maximize the chances of detecting colostomy-related complications.
Results:
There were 80 neonates with anorectal malformations, of whom, 49 (31 boys and 18 girls) were included in the study. The site of colostomy was sigmoid colon (n = 32), transverse colon (n = 7), and descending colon (n = 10). Thirty-nine colostomies were loop, and the remaining 7 were divided. The median birth weight was 2.96 kg (range, 1.46 to 3.88). The age at colostomy formation was 2 days (range, 1 to 210). Mechanical complications related to colostomy formation were observed in 16 infants (32%) with 3 infants having more than 1 mechanical complication. These included prolapse in 8 (50%), intestinal obstruction (adhesions, intussusception, and volvulus) in 7 (44%), and skin dehiscence in 3 (19%). One neonate had necrotizing enterocolitis (NEC) after colostomy formation. Urinary tract infection was observed after colostomy in 14 infants (29%). The incidence of urinary tract infection was not higher in infants who had loop colostomy (11 of 39, 28%) compared with infants who had divided colostomy (3 of 10, 30%). There were no differences in the incidence of colostomy-related complications and urinary tract infection between male and female infants. There were no deaths in this series.
Conclusions:
Formation of colostomy for anorectal anomalies should not be considered a minor procedure. In our experience the incidence of complications after colostomy formation is high. The incidence of urinary tract infections does not seem to be affected by the type of colostomy performed.