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Temporary Diverting End-Colostomy in Critically Ill Children with Severe Perianal Wound Infection
Emrah Gün1, Tanil Kendirli, Edin Botan
1At the Ankara University School of Medicine, Turkey, Emrah Gün, MD, is Fellow, Department of Pediatric Critical Care Medicine; Tanil Kendirli, MD, is Professor, Department of Pediatric Critical Care Medicine; Edin Botan, MD, is Fellow, Department of Pediatric Critical Care Medicine; Halil Özdemir, MD, is Associate Professor, Department of Pediatric Infectious Disease; Ergin Çiftçi, MD, is Professor, Department of Pediatric Infectious Disease; Kübra Konca, MD, is Fellow, Department of Pediatric Infectious Disease; Meltem Koloğlu, MD, is Professor, Department of Pediatric Surgery; Gülnur Göllü, MD, is Associate Professor, Department of Pediatric Surgery; Özlem Selvi Can, MD, is Associate Professor, Department of Pediatric Anesthesia; Ercan Tutar, MD, is Professor, Department of Pediatric Cardiology; Ahmet Rüçhan Akar, MD, is Professor, Department of Cardiovascular Surgery, Heart Center, Cebeci Hospitals; and Erdal İnce, MD, is Professor, Department of Pediatric Infectious Disease. Acknowledgments: The authors wish to thank all the pediatric ICU nursing staff for all their efforts and support for our critically ill pediatric patients. The authors have disclosed no financial relationships related to this article. Submitted June 24, 2020; accepted in revised form September 25, 2020.
Insights
Temporary protective colostomy can be a life-saving intervention for critically ill children with severe perianal wounds. This procedure helps manage infection and promotes healing in complex pediatric intensive care unit cases.
Area of Science:
- Pediatric Critical Care Medicine
- Wound Management
- Surgical Interventions
Background:
- Perianal wounds in pediatric intensive care units (PICUs) present significant challenges due to potential contamination with gastrointestinal flora, leading to sepsis and prolonged recovery.
- Managing these wounds requires controlling infection without diverting stool, a complex task often complicated by the limited awareness of protective colostomy among pediatric critical care specialists.
Purpose of the Study:
- To evaluate the efficacy of temporary protective colostomy in managing severe perianal wounds in critically ill children.
- To highlight the benefits of this surgical approach in complex pediatric critical care scenarios.
Main Methods:
- Case series presentation of three critically ill children requiring temporary protective colostomy for perianal wounds.
- Conditions included meningococcemia with extensive tissue loss and dilated cardiomyopathy necessitating a total artificial heart with a large pressure injury.
Main Results:
- Temporary protective colostomy was beneficial in all three pediatric cases, facilitating the recovery of perianal wounds.
- The intervention helped prevent fecal contamination and supported wound healing in patients unresponsive to conventional treatments.
Conclusions:
- Temporary diverting colostomy is a valuable, though not widely recognized, option for pediatric critical care specialists managing severe perianal wounds.
- Early consideration of this procedure can prevent fecal transmission, accelerate wound healing, and improve survival in critically ill children.
Abstract:
Broad and deep perianal wounds are challenging in both adult and pediatric ICUs. These wounds, if contaminated with gastrointestinal flora, can cause invasive sepsis and death, and recovery can be prolonged. Controlling the source of infection without diverting stool from the perianal region is complicated. The option of protective colostomy is not well-known among pediatric critical care specialists, but it can help patients survive extremely complicated critical care management. These authors present three critically ill children who required temporary protective colostomy for perianal wounds because of various clinical conditions. Two patients were treated for meningococcemia, and the other had a total artificial heart implantation for dilated cardiomyopathy. There was extensive and profound tissue loss in the perianal region in the patients with meningococcemia, and the patient with cardiomyopathy had a large pressure injury. Timely, transient, protective colostomy was beneficial in these cases and facilitated the recovery of the perianal wounds. Temporary diverting colostomy should be considered as early as possible to prevent fecal transmission and accelerate perianal wound healing in children unresponsive to local debridement and critical care.
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