Childhood colostomy and its complications in Lagos

Abstract

Childhood colostomy is often indicated for obstructive congenital lesions of the colon and anorectum as well as a few acquired ones. In a prospective 3-year study of 66 childhood colostomies performed at the Lagos University Teaching Hospital, 33 (50%) were fashioned for Hirschsprung's disease while 28(42.50/0) stomas were fashioned for anorectal anomalies. Eighty complications were recorded in 27 (40.9%) of the 66 colostomies. There were 13 (19.7%) early complications comprising of 3 (4.5%) cases each of hemorrhage and septicaemia and 2 (300) each of colostomy retraction, non-function and stoma1 necrosis. One patient developed necrotising fasciitis. Skin excoriation was the commonest complication, and was seen in 22 (33.3%) of the patients. Colostomy diarrhoea occurred in 20 patients and was responsible for almost all the excoriations. Prolapse was seen in 12 (18.200) colostomies. Failure to thrive accompanying frequent colostomy diarrhoeas was seen in 8 (12%). One case each of parastomal fistula was recorded. Of the 54 colostomies closed by the end of the study period, 10 (18.5%) developed complications. Wound infection was observed in 4 (7%) and intestinal obstruction was seen in 3 (5.5%). Two of the latter were from stenosis at the closed colostomy site while one resulted from adhesive bowel obstruction. Faecal fistula developed in 2 (3.700) other cases while one case of incisional hernia was recorded. Although 4 (60/0) of the children died within the study period, only one (1.5O0) was attributable to the colostomy. The presence of a colostomy is associated with significant morbidity in children. To minimize these problems, the paediatric surgeon must pay close attention to the fashioning, management and closure of a colostomy. The dearth of stoma care nurses for home visits and supervision of stoma care remains a big challenge in our setting.