Colostomy Complications Research Articles

The treatment of high and intermediate anorectal malformations: One stage or three procedures?

Background/Purpose The aim of this study was to examine the safety, feasibility, and the long-term outcome of complete 1-stage repair of high and intermediate anorectal malformation using posterior sagittal anorectoplasty (PSARP) in a neonate. Methods One hundred thirteen patients with high-type and intermediate-type anorectal malformations (ARM) underwent follow-up. Of 113 cases, 48 cases entailed a divided colostomy, definitive operation, and colostomy closure (group I); the other 65 patients underwent 1-stage PSARP (group II). Anorectal function was measured by the modified Wingspread scoring, including “excellent,” “good,” “fair,” and “poor.” In barium enema studies, anorectal angulation was judged as “clear,” “unclear,” and “not present,” and leakage of barium was observed in the meantime. For anorectal manometric studies, anal resting pressure (ARP), anal squeezing pressure (ASP), and positive anorectal reflex (PAR) were measured. Results In group I, the rate of excellent and good scores was 58.3% (28 of 48). In the barium enema examination, 85.4% (41 of 48) was clear and 14.6%(7 of 48) unclear or not present. The rate of barium leakage was 10.4% (5 of 48). In group II, the rate of excellent and good was 53.8% (35 of 65). Anorectal angulations were clear in 83.1% of patients (54 of 65). Barium leakage happened in 7.69% of patients (5 of 65). Early operative complications occurred in 56.3% (27 of 48) of patients in group I and 29.2% (19 of 65) in group II. The incidence of colostomy complications in group I was 39.6% (19 of 48). Soiling and constipation were the major complications after the PSARP operation. The respective rates of constipation in the 2 groups were 47.9% (23 of 48) and 44.6% (29 of 65), and the respective rates of soiling were 47.9% (23 of 48) and 50.8% (33 of 65). There was no significant difference in the mean ARP between the 2 groups. Conclusions The 1-stage PSARP procedure in the neonate not only achieves the same long-term outcome as the conventional PSARP procedure but also involves fewer short-term complications. Complete 1-stage repair using the PSARP to treat high-type and intermediate-type anorectal malformations is safe and feasible.

Morbidity and mortality of colostomy and its closure in children

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.

Emergency neonatal surgery in a developing country

With better understanding of neonatal physiology and improvements in diagnostic facilities and neonatal intensive care units (NICU), the outcome of neonatal surgery has improved in developed countries. In developing countries, however, neonatal surgery is problematic, particularly in the emergency setting, but there are few reports from these countries. A retrospective analysis of 154 neonates who had emergency surgery over a 10-year period at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, was undertaken. Emergency surgery represented 40% of surgical procedures in neonates in the hospital. The majority of the patients (94.8%) were delivered at home or in rural health centers. The median weight was 2.7 kg (range 2.0-3.7 kg). In 89 cases (58%) the indications for surgery were intestinal obstruction, anorectal malformations in 60(67%) and in 33(21%) complicated exomphalos or gastroschisis. Nine patients (6%) required surgery for ruptured neural-tube defects. A colostomy was the commonest procedure (51, 33%), 27(53%) of which were performed using a local anesthetic without adverse effects. Thirty-three abdominal-wall defects were closed by various methods (fascial closure 23, skin closure 6, improvised silo 4). Overall, 37 (24%) procedures were performed using local anesthesia. Fifty-nine patients (38%) developed postoperative complications (infections 33, respiratory insufficiency 16, colostomy complications 8, anastomotic leak 2). The mortality was 30.5%, 66% due to overwhelming infection, 28% to respiratory insufficiency, and 4.3% to multiple anomalies. Other factors considered to have contributed to morbidity and mortality were late referral and presentation and a lack of NICUs. Thus, emergency neonatal surgery is attended by high morbidity and mortality in our environment at the present time. Early referral and presentation and provision of NICUs should improve the outcome.

Surgical treatment of parastomal hernia complicating sigmoid colostomies.

Parastomal hernia is a common late complication of colostomy. Surgical approach to the repair of parastomal hernia is controversial. Results of surgical treatment are disappointing. The aim of this study was to assess the outcome of surgical treatment of parastomal hernia. This article reports a retrospective review of those patients who had undergone a surgical treatment of parastomal hernia complicating sigmoid colostomy. The indications, surgical procedures, complications, and outcome were carefully studied. There were 43 surgical treatments of parastomal hernia. Sixteen underwent simple local repair; 25 stomas were relocated, and 2 were locally repaired with mesh. Overall recurrence was 18 of 40 (45 percent). Recurrences for fascial repair and stoma relocation were 6 of 13 (46 percent) and 10 of 25 (40 percent), respectively. Stoma relocation could be accomplished without formal laparotomy in 19 of 25 cases. Incisional hernia occurred in only 2 of these 25 relocations. Fascial repair alone can be performed for symptomatic small hernias because of its advantage of minimal morbidity. Stoma relocation without formal laparotomy can be advocated for larger hernias. A combination of local resite together with mesh reinforcement may be the alternative for further improvement of results.

Colostomy complications — a surgical failure or a population problem

Stoma related complications vary from population to population. This study was undertaken in order to compare the complications associated with the most frequently constructed stomata at King Faisal Specialist Hospital (loop transverse, loop sigmoid and end colostomy) and those previously reported by one of the authors from a different population in New Zealand. Diverting stomata were of the dependant loop type. All operations were performed by or under the supervision of the same surgeon. One hundred and forty-one colonic stomata were fashioned in 137 patients (72 men, 65 women). There were 74 end stomata, 60 loop transverse and 7 loop sigmoid colostomies. One hundred and twenty-seven stomata were fashioned electively and 14 were constructed as emergencies. One patient died post operatively from overwhelming sepsis following colonic perforation. Follow-up varied from 1 to 72 months and most complications occurred within the first 6 months. The overall stoma complication rate was 22.7%. The complication rate was highest in patients in whom a loop transverse colostomy was performed. Stoma related complications were fewer in males than females (18.9% vs. 26.9%) and higher in patients having an emergency rather than an elective stomata (35.7% vs. 21.3%) although these differences did not reach statistical significance. Patients with stomata and early (Dukes Stage A and B) cancer had fewer stoma related complications (15.7%) than more advanced patients (25%). These differences were not statistically significant either. The overall stoma related complication rate in the New Zealand study was 11.1% and this was significantly different from the rate recorded in the present study (p<0.01).

MASSIVE BLEEDING FROM ILEAL CONDUIT PERISTOMAL VARICES: SUCCESSFUL TREATMENT WITH THE TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT

Bleeding from stomal varices is a rare but well-known complication of ileostomy, colostomy and ileal conduits in patients with portal hypertension.' Treatment of these often severe hemorrhages is controversial. Conservative local measures are associated with high recurrence rates and extensive surgical shunting procedures are frequently not indicated in the high risk cirrhotic patient. Transjugular intrahepatic portosystemic shunt is a recently described technique for treating complications of portal hypertension. We report our experience using this procedure in a patient with massive peristomal bleeding. CASE REPORT

Initial experience with one-stage endorectal pull-through procedures for Hirschsprung's disease

To evaluate our experience with one-stage endorectal pull-through (ERPT) procedures (without colostomy) for Hirschsprung's disease (HD), we compared 7 such patients to a cohrt of 20 consecutive patients undergoing EROT folowing colostomy. Reasons for exclusion from hte cohort group included: (1) bowel obstruction requiring operation before 1 month of age; (2) presentation with enterocolitis (EC), intestinal perforation, or massive fecal distension; (3) long-segment disease; or (4) severe associated anomalies. The 7 male patients in the single-stage ERPT group first presented at a median age of 16 days (4 days-2.5 years) and were managed by regular digital dilation or colonic irrigation for between 1 and 6 months (median 2 months) prior to surgery. Single-stage procedures were performed at a median age and weight of 4 months (2 months-2.5 years) and 6.4 kg (4.5-13.8 kg), respectively Median hospitalization for these patients was 9 dyas. Postoperative complications occurred in 2 patients (29%), and included anastomotic stricture requiring outpatient dilation, and 1 case or recurrent EC that responded to a course of anal dilations. The cohort group (14 M, 6 F) presented at a median of 15 months. All underwent colostomy as a primary procedure. ERPT was deferred until a median age of 21 months, and the hospitalization after pull-through averaged 10 dyas (20 days including stay after colostomy). Four patient (20%) developed complications requiring reoperation following the initial colostomy. Complications after ERPT occurred in 5 patients (25%) and included 1 death from fulminant Hirschsprung's EC. Other complications included 1 anastomotic stricture and 2 mucosal prolapses requiring anoplasty. Long-term functional results were similar in both groups. Despit our limited experience, we conclude that one-stage ERPT can be safely performed in infants, including those under 3 months of age, with rectosigmoid HD. Total duration of hospitalization is reduced and colostomy complications are avoided. Functional outcome appears to be comparable between patients treated in one or two stages.

Loop colostomy for management of rectal tears and small-colon injuries in horses: 10 cases (1976-1989)

Summary Loop colostomy was performed in 10 horses as treatment for grade-III rectal tears (n = 6 horses), small-colon infarction (n = 2 horses), perirectal abscess and stenosis (n = 1 horse), and small-colon stricture (n = 1 horse). In 7 horses, the colostomy was constructed through a single incision low in the left flank, with closure of the incision around the stoma (single-incision technique). In 3 horses, 2 of which had colostomy performed as a standing procedure, the selected segment of small colon was placed from a flank incision into a separate, small incision low in the left flank (double-incision technique). Five horses underwent colostomy reversal (at 18 to 63 days) and 2 of these horses, both with grade-III rectal tears, recovered completely. Of 8 horses that did not survive, 6 died from the primary disease or associated complications. Technical problems associated with colostomy accounted for death of 2 horses. One horse had gastric rupture attributable to suture occlusion of the small intestine after colostomy reversal, and another horse had complications of incisional infection after repair of a peristomal hernia. Small-colon prolapse through the stoma necessitated premature reversal of the colostomy in a horse that was euthanatized because of worsening laminitis. Minor complications of the colostomy procedure were partial stomal dehiscence (n = 4 horses), partial dehiscence of the flank wound after colostomy reversal (n = 2 horses), and small ventral midline hernia after colostomy reversal (n = 1 horse). Loop colostomy may be of benefit to horses with rectal tears, provided it is done soon after the tear occurs. The double-incision technique for loop colostomy is recommended, because it appeared to reduce the risks of peristomal herniation and stomal prolapse. Other recommendations are made to reduce complications of colostomy and facilitate reversal.

Complications of colostomy performed on gynecologic cancer patients

From 1/1/80 to 5/31/90 111 patients underwent a colostomy on a gynecologic oncology service. Six patients developed 7 (6.3%) early colostomy-related complications, including sepsis (1), stomal retraction (1), ostomy wound infection (3), and partial stomal obstruction (2). The sepsis was felt to be related to spillage of stool upon maturing the colostomy, and this patient expired on Postoperative Day 63. There were no other mortalities attributed to the colostomies. Fourteen patients developed 17 (15.3%) delayed colostomy-related complications, including parastomal hernia (5), stomal retraction (1), stomal prolapse (3), tumor replacement (2), and site-choice problems (6). These results compare favorably with those in the literature and support the continued role of the gynecologic oncologist in gynecologic cancer-related gastrointestinal surgery.

Complications of colostomy closure

A series of 126 colostomy closures was analyzed to evaluate factors contributing to morbidity. There were no deaths, but there was a 33 percent complication rate. Patients with penetrating abdominal trauma and foreign-body rectal perforations had fewer serious complications following colostomy closures than patients with diverticulitis or cancer. No significant difference was found in the anastomotic leak rate, length of surgery or length of hospitalization in patients with sutured or stapled anastomoses. Most patients in this series had end colostomies that required limited resection and anastomoses. Complication rates were comparable with previous series, which consisted predominantly of loop colostomy closures. The incidence of surgical complications was not related to the time interval between colostomy formation and closure. Timing of closure, however, significantly influenced the complication rate in two specific patient groups: patients with intraperitoneal colon perforation at the initial procedure when closure was performed within four weeks, and patients with surgical complications at the time of colostomy creation if they underwent closure within eight weeks. Early closures in patients still recovering from colostomy complications were associated with the highest incidence of anastomotic leak. Wound infections at stoma sites were decreased by leaving the skin open. The average hospitalization was 11.1 days for patients without complications, 15.5 days for those with wound infection, 18.5 days for patients with ileus, and 20.4 days for patients with anastomotic leaks. This study illustrates that the optimal time for colostomy closure must be determined on an individual basis. The morbidity can be minimized by delaying closure in specific groups of patients for one to two months. Delaying closure for an arbitrary time interval in all patients, however, is not warranted.

Colostomy complications in children—An analysis of 146 cases: D. L. Mollitt, M. A. Malangoni, T. V. N. Ballantine, et al. Arch Surg 115:455–458, (April), 1980

Colostomy complications in children—An analysis of 146 cases: D. L. Mollitt, M. A. Malangoni, T. V. N. Ballantine, et al. Arch Surg 115:455–458, (April), 1980

Colostomy complications in children. An analysis of 146 cases.

This report analyzes the course of 146 pediatric patients with colostomies in reference to problems with colostomy formation, management, and subsequent closure. Colostomy was performed predominantly for Hirschsprung's disease (70 cases) and imperforate anus (46 cases). A transverse colostomy was done in 120 patients (82%), and a sigmoid colostomy in the remaining patients. Loop colostomies were five times more frequent than divided colostomies. Early major complications occurred in 24 patients (16%). Stomal complications occurred in 69 patients and were more frequent after loop colostomies. Colostomy revision was required in 24 cases. Sigmoid colostomy had a significantly lower complication rate (P less than .01). One hundred nine patients underwent colostomy closure. Major complications occurred in 16 cases (15%). There were no deaths related to colostomy closure. The use of a sigmoid colostomy when possible and close attention to technical details, principles of stomal care, and proper parental instruction should minimize morbidity.

2. Complications of Colostomy and Their Preventions

During past 18 years, between 1962 and 1979, 409 cases of colostomy and 8 cases of ileostomy were established at the Social Insurance Central Hospital. Up to 1966, there were fatal complications, 2 cases of necrosis result in peritonitis, a case of late ileus and 2 cases of perforation. At that time we had employed coventional procedure.Since then extraperitoneal primary open colostomies have been established. In these procedure there were no severe complications, but 5 cases of stricture, 6 cases of hernia, 4 cases of prolapse were encountered. Careful management which doesn't make to much incision of the fastia of the abdominal oblique muscles prevents paracolostomy hernia and prolapse.If stricture occurred at the stomal limb, it is not considered that repair of stenotic site will be followed by good result. The simple best way in such case is a loop colostomy of the transverse colon.

6 - The Colon: Part I: Complications of Ileostomy and Colostomy Following Excisional Surgery

6 - The Colon: Part I: Complications of Ileostomy and Colostomy Following Excisional Surgery

Complications of pediatric colostomy

Complications of pediatric colostomy

Complications of colostomy.

A review of 200 colostomies showed that the incidence of complications was 11 per cent. Prolapse was the most common complication. Indications for colostomy and factors resulting in complications are mentioned. Technics that may prevent or reduce the incidence of complications are briefly discussed.

Transverse colostomy in the management of cancer of the colon.

Summary The indications, time factors, results and complications of the transverse colostomy when used at some time in the course of management of 45 patients with cancer of the large bowel are reviewed. The transverse colostomy is safe and effective for decompression, but when it was needed to alleviate acute obstruction only approximately half of the patients subsequently completed the three staged procedures. An average of 94 days was required for completion of the staged operations. Significant complications are associated with closure of the transverse colostomy. The survival rate in 45 patients with cancer of the colon who had transverse colostomies was extremely poor—8.8 per cent survived five years. Colostomy closure was not achieved in 42 per cent of the patients. It is suggested that when possible, reconsideration be given to Mikulicz resection for management of obstructing lesions of the proximal colon. When a transverse colostomy has been established to alleviate obstruction closure at the time of resection would be desirable, in view of the poor prognosis for these patients and in order to decrease hospitalization and the need for a further major surgical procedure, with its attendant risks and expense.

Complications of colostomy.

Summary In a series of 307 colostomies established in 296 patients, there were complications in 53 patients (16 per cent), of whom 41 had reoperations to correct the complications. One patient died of sepsis following operation for a perforation caused by an irrigating catheter.

COMPLICATIONS OF COLOSTOMY AND THEIR MANAGEMENT

Objectives: To know about the incidence of different complications of colostomy and to take appropriatemeasures to prevent and treat these complications.Material and Methods: This prospective study was carried out in surgical unit Saidu Teaching HospitalSaidu Sharif Swat from Feb 2009 to Jan 2012. All patients of both sexes from new born up to 80 years of ageadmitted to surgical unit who underwent colostomy were included in the Study. Complications associatedwith colostomy were recorded.Results: Total number of patients was 60. Colostomies performed in infants and Children were mainly forAnorectal Malformation or Hirschsprung's disease, who were later on sent for definitive procedures, tospecialized units, while in Adults it was done for Colorectal Carcinoma, Trauma , high Level Fistula in Anoor Colovesical Fistula. In 39 patients sigmoid while in 21 patients transverse colostomy was constructed.Complications related to colostomy occurred in 23 ( 38.33%) patients. Diarrhea, Skin Excoriation, Hairaround Colostomy, Propalse and Wound infection were the common post operative complications . 6(10%)patients, 4 infants and 2 adults died postoperatively.Conclusion: Well fashioned and properly placed Colostomy, proper Stoma care, application of goodquality and well fitted Colostomy appliance, education about colostomy care and early treatment ofColostomy Diarrhea are important factors for prevention of different complications.Key Words: Colostomy, complications, colorectal Carcinoma.

Gastric herniation as a complication of transverse colostomy.

Herniation of the stomach at the site of a transverse colostomy must be rare, for no reference pertinent to its occurrence could be found on a survey of the literature. The following case illustrates the problems encountered in the diagnosis of this entity and the difficulty of its differentiation from volvulus of the right colon. A 76-year-old white female was admitted on Feb. 8, 1952, in the early evening, with symptoms of abdominal pain, distention, progressive constipation, and weight loss. Blood had been noted in the stool on one occasion about a month previously. On physical examination loops of distended bowel were visible, bowel sounds were markedly reduced, and there was diffuse abdominal tenderness. Admission scout films of the abdomen indicated a low colonic obstruction, probably neoplastic, and two hours later a transverse colostomy over a glass rod was performed. The bowel was decompressed with a needle, but not opened until the following morning. At that time moderate amounts of gaseous, fluid, and fecal matter were obtained, with a decrease of abdominal distention. The patient's condition continued to improve until Feb. 13, when she complained of severe abdominal pain. Clinical examination showed gangrene of a loop of the large intestine over the glass rod and, in addition, an air-filled viscus (small intestine?) pushed up into the wound. From the scout films, which demonstrated a distended gas-filled viscus in the upper abdomen, a volvulus of the cecum was suspected. A barium-enema examination disclosed complete obstruction of the sigmoid with findings characteristic of car-cinoma. During the examination the gas-filled viscus increased in size and again was judged to represent an ectopic cecum with obstruction due to volvulus. Delineation of the full thickness of the viscus wall by gas was attributed to pneumoperitoneum resulting from the recent surgery. On re-operation, the herniation of bowel around the transverse colostomy was again noted but, when the incision was enlarged, the dilated viscus proved to be the stomach. This was returned to the abdominal cavity. The entire intestine, both small and large, appeared gangrenous or on the verge of gangrene, the result, apparently, of extensive thrombosis of all the mesenteric vessels. The stomach on its return to the abdomen was normal in color. A large constricting carcinoma was identified in the sigmoid. At this time the patient was almost in extremis, and the abdomen was closed. Death occurred shortly afterward.