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The use of diverting colostomies in paediatric peri-anal burns: experience in 45 patients
1Department of Plastic and Reconstructive Surgery, University of Cape Town, Cape Town, South Africa. cprice2006@gmail.com
Insights
Temporary diverting colostomy significantly improves outcomes for pediatric patients with perianal burns, reducing complications and enhancing graft survival. This procedure is vital for managing severe burn cases involving the perianal area.
Area of Science:
- Pediatric Surgery
- Burn Management
- Gastrointestinal Surgery
Background:
- Peri-anal burns are common in children and pose risks of infection, graft loss, and functional impairment due to enteric organism contamination.
- Temporary diverting colostomy is a surgical approach advocated to mitigate these severe complications in pediatric burn patients.
Purpose of the Study:
- To evaluate the incidence, indications, surgical methods, bacteriology, therapeutic effectiveness, and patient outcomes associated with colostomy for peri-anal burns in children.
- To analyze the impact of fecal diversion on wound healing, infection control, and overall patient recovery.
Main Methods:
- A prospective 17-year study (1995-2012) involving children with peri-anal burns who underwent temporary, divided sigmoid end-colostomy.
- Colostomies were performed prophylactically in 29 patients and therapeutically in 16 patients, with distal closure using Hartmann's technique.
Main Results:
- 45 children with peri-anal burns received colostomies; the average burn size was 35% TBSA.
- Significant improvements in clinical appearance, graft take, and healing were observed in most patients.
- Complications occurred in 11.1% of cases, including two deaths from septic shock; colostomy reversal occurred at an average of 4 months.
Conclusions:
- Diverting colostomy offers significant therapeutic benefits for select pediatric burn patients.
- The procedure effectively manages the threat of fecal soiling, thereby protecting grafts and improving survival rates in severe peri-anal burn cases.
Background:
Peri-anal burns are common in children. Continual exposure to enteric organisms may lead to a contaminated burn wound, invasive sepsis, graft loss, scar contracture, anal and urinary malfunction, and delayed discharge from hospital. Use of a temporary diverting colostomy has been advocated to reduce complications.
Objectives:
To review the incidence, indications, methods, bacteriology, therapeutic effects and outcomes of colostomy for perianal burns.
Methods:
A prospective study of children with peri-anal burns and stomas over a 17-year period. Prophylactic or therapeutic faecal diversion was achieved by temporary, divided sigmoid end-colostomy with Hartmann's closure of the distal end.
Results:
Between 1995 and 2012, 45 children with peri-anal burns received a colostomy. The mean total body surface area burned was 35% (range 3 - 80%). There were 28 flame burns, 16 fluid burns and 1 contact burn. Prophylactic colostomies were performed in 29 children, on average on day 6 after admission, and therapeutic colostomies to counteract deep wound infection and septicaemia in 16 patients, on average on day 24. In all but 2 cases there was a marked improvement in clinical appearance, graft take and healing. The bacterial profile changed from gut-derived organisms to Pseudomonas aeruginosa or no pathogens. Complications occurred in 5 patients (11.1%). Three stomas required manual reduction. Two children died of established septic shock, compounded by stomal dehiscence in 1 case. Reversal of the colostomy was performed on average at 4 months.
Conclusion:
Diverting colostomy has therapeutic advantages in a select group of paediatric burns patients in whom continual faecal soiling poses a threat to both graft and life.
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