Patterns and indication of colostomies in Addis Ababa, Ethiopia

Though colostomy is one of the frequently performed procedures, information from Ethiopia is lacking concerning its most frequent indications, types and the complications seen after its formation.

A retrospective analysis of 155 patients operated at Tikur Anbessa (TAH) and the Saint Paul's Hospital (SPH) over a three year period (2004-2007 E.C).

155 patients were included in the analysis, their male to female ratio being 2.9:1. Non-traumatic disease conditions accounted for 124 (80%) patients. The most frequent disease conditions that necessitated the formation of colostomy were gangrenous sigmoid volvulus in 56 (36.1%), Colonic cancer in 45 (29%) and Colonic trauma in 31 (20%) of the patients. The sigmoid colon in 96 (70%) and the rectum in 30 (19.4%) were the specific segments of the colon diseased. Hartmann's and loop colostomy were the most common types of colostomies performed in 94 (60.6%) and 39 (25.2%) of the patients respectively. Fifty-five complications (of whom 21 were stomal) were seen among 37 (23.8%) of the patients. There were thirty-one (20%) in-hospital deaths. Only 87(70.1%) of those discharged improved had their colostomy reversed.

Colostomy is one of the procedures commonly performed in the two teaching Hospitals. Sigmoid volvulus, colorectal cancer and trauma are the leading indications. Most of the colostomies are done as emergency surgery by residents under training. Involving senior staff in the handling of these cases may reduce the need for colostomy and, to some extent, could decrease the stoma related complications that may result from technical failure. Significant proportions of those discharged improved failed to get their colostomies reversed.