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Colostomy complications in infants and children
A H al-Salem1, C Grant, S Khawaja
1Department of Surgery, King Fahd Hospital of the University, Al-Khobar, Saudi Arabia.
Insights
Sigmoid loop colostomies show fewer complications than transverse colostomies in pediatric patients. This finding suggests sigmoid loop colostomy is preferable when possible for better patient outcomes.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
Background:
- Colostomies are frequently performed in pediatric patients for various congenital gastrointestinal anomalies.
- Stomal complications are a significant concern following colostomy formation in neonates and infants.
Purpose of the Study:
- To evaluate the types of colostomies performed in a pediatric population.
- To determine the incidence and types of stomal complications.
- To identify factors associated with colostomy complications and outcomes.
Main Methods:
- Retrospective review of 77 colostomies in 74 pediatric patients.
- Analysis of colostomy types, indications, patient demographics, and complication rates.
- Comparison of complication rates between different colostomy types.
Main Results:
- High complication rate (74.6%) observed across all colostomy types.
- Sigmoid colostomy (52%) had a significantly lower complication rate than transverse colostomy (81%).
- Deaths directly related to colostomy formation were rare (2.7%).
Conclusions:
- Colostomy formation in pediatric patients is associated with a high incidence of stomal complications.
- Sigmoid loop colostomy is associated with a lower complication rate and should be considered preferentially.
- While complications are frequent, mortality directly attributed to colostomy is low.
Abstract:
Seventy-seven colostomies were performed in 74 patients: 35 for high anorectal agenesis, 34 for Hirschsprung's disease, 2 for necrotizing enterocolitis, 2 for small left colon syndrome, and 1 for volvulus neonatorum with perforation. There were 55 boys and 19 girls with a mean age of 0.8 years. The different types of colostomies performed were: transverse loop in 48, sigmoid loop in 21, transverse end in 4, descending end in 2, sigmoid end in 1, and transverse double barrel in 1. Forty-seven patients developed stomal complications (74.6%). Eleven patients died, but only in 2 (2.7%) were the deaths directly related to colostomy formation. Five patients required stomal revision (6.8%). The incidence of complications was neither related to the age nor to the primary indication for the colostomy, but sigmoid colostomy was associated with a lower complication rate compared to transverse colostomy (52% versus 81% 0.02 greater than p greater than 0.01). A sigmoid loop colostomy should be used whenever possible.