Morbidity and mortality of colostomy and its closure in children

doi:10.1016/j.jpedsurg.2003.12.016

Journal of Pediatric Surgery

Volume 39, Issue 4, April 2004, Pages 596-599

https://doi.org/10.1016/j.jpedsurg.2003.12.016 Get rights and content

Abstract

Background

This study evaluated the complications of colostomy and its closure in infants and children.

Methods

One hundred forty-six colostomies were performed in 86 neonates, 23 infants, and 37 children older than 1 year. These children underwent colostomies for anorectal malformation (84), Hirschsprung’s disease (47), and other miscellaneous (15) conditions like colonic atresia, volvulus, rectal tuberculosis, traumatic rectal perforation, and intestinal obstruction caused by ascariasis.

Results

Of these, 17 (11.6%) had early complications, and 80 (69.8%) had stomal complications. Three patients died, but only 1 death was directly related to colostomy. Colostomy prolapse, peristomal excoriation, and malnutrition were the major complications. The complications were not dependant on the children’s age or primary indication. Sigmoid colostomy had a lower malnutrition rate than transverse colostomy (34.9% v 16.9% P = .009). Among the 56 children who underwent colostomy closure, major complications include death (1.8%), anastomotic leak (7.1%), and wound infection (12.6%).

Conclusions

A divided sigmoid colostomy should be performed whenever possible. Proper stomal care, regular nutritional assessment, and early closure of the colostomy would minimize morbidity and mortality of colostomy and its closure.

Section snippets

Colostomy

One hundred forty-six colostomies were performed during the study period (January 1992 to June 1999) in the pediatric surgery unit of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Pondicherry, India. The youngest was a day-old newborn, and the eldest was 12 years of age, the latter being a patient with posttraumatic complete perineal tear. The various indications of colostomy, performed during the study, are shown in Fig 1. The different types of colostomies

Mortality

There were 2 deaths (1.4%). Only 1 (0.7%) was directly related to the performance of colostomy; he had peristomal subcutaneous emphysema caused by synergistic gangrene and died of septicemia. The other child died of cyanotic heart disease, which was associated with imperforate anus, dextrocardia, and Turner’s syndrome.

Early complications

There were 22 early complications. Three patients who presented with intestinal obstruction had pericolostomy hernia (2.1%). The hernia was reduced, and the rectus defect was

Discussion

Mortality caused by the performance of colostomy is rare and varies from 0% to 9.5%.5, 6, 7, 8 It is predominantly owing to the associated cardiac anomalies. Morbidity (Table 1) owing to colostomy has changed very little over the last 2 decades.1, 5, 9, 10 Nutritional aspect associated with colostomy, which was widely reported initially,11 lost its importance later, and malnutrition has resurged as an important complication (23.9%) in the current study. In spite of the initial speculation

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Evaluation and treatment of the post pull-through Hirschsprung patient who is not doing well; Update for 2022
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After operative intervention for Hirschsprung disease (HD) a child should thrive, be fecally continent, and avoid recurrent episodes of abdominal distention and enterocolitis. This is unfortunately not the case for a significant number of patients who struggle following their pull-through procedure. Many clinicians are puzzled by these outcomes as they can occur in patients who they believe have had a technically satisfactory described operation. This review presents an organized approach to the evaluation and treatment of the post HD pull-through patient who is not doing well.
Patients with HD who have problems after their initial operation can have: (1) fecal incontinence, (2) obstructive symptoms, and (3) recurrent episodes of enterocolitis (a more severe subset of obstructive symptoms). After employing a systematic diagnostic approach, successful treatments can be implemented in almost every case. Patients may need medical management (behavioral interventions, dietary changes, laxatives, or mechanical emptying of the colon), a reoperation when a specific anatomic or pathologic cause is identified, or botulinum toxin when non-relaxing sphincters are the cause of the obstructive symptoms or recurrent enterocolitis.
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A retrospective dual-center case–control study of children undergoing PSARP without colostomy between 2011 and 2019 was performed. The VAC group received preoperative bowel preparation (PBP), postoperative application of a VAC, loperamide (only Location A), intravenous antibiotics (IA), and total parenteral nutrition (TPN). The non-VAC group underwent PBP, loperamide (Location A), IA, and TPN without VAC. Primary outcome was WD at the anocutaneous anastomosis or reconstructed perineal body within the first 14 days after surgery.
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16-months old male with postoperative state of tracheoesophageal fistula and rectovestivular fistula. He had transverse loop colostomy in neonatal period and PSARP in 12 months of life. During the colostomy closure, ICG was intravenously administered to evaluate blood flow of anastomotic site. Twenty-five hours after operation, he had the first defecation which was negative for ICG fluorescence. Forty hours after operation, he had ICG-positive defecation. There were no postoperative complications for both of patients.
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Morbidity and mortality of colostomy and its closure in children

Abstract

Background

Methods

Results

Conclusions

Section snippets

Colostomy

Mortality

Early complications

Discussion

J Pediatr Surg

Clin Gastroenterol

J Pediatr Surg

J Pediatr Surg

Am J Surg

Am J Surg

Am J Surg

Care of the child with a colostomy

Pediatrics

Colostomy in infants and children

Surg Gynecol Obstet

Nutrition and nutritional disorders