Colostomy In Children Research Articles

Incidence of Complications of Colostomy in Children with Hirschsprung Disease and Anorectal Malformation

Colostomy formation, A surgery used in the management of Hirschsprung's disease, and anorectal malformations. colostomy complications were represented both in children with Hirschsprung's disease and in those with anorectal malformation Objective: To estimate the incidence rate of major complications after colostomy formation surgery. Methods: A prospective longitudinal descriptive study was performed to calculate the incidence rates of complications following the surgical intervention of colostomy formation. All 200 cases of consecutive young children (age 2 days to 60 days) who received a colostomy between (date January 2017 to January 2020) were included. The incidence of major colostomy-related complications was calculated. This was analyzed for colostomy formation. Non-colostomy-related complications were not included in study. Results: 200 young children were included. And a follow-up of 6 months of this study to review the complications of colostomy formation in infants and children with Hirschsprung's disease or an anorectal malformation. 80% experienced colostomy-related complications, colostomy prolapse (35% in HD more with a transverse colostomy, 20% in Anorectal malformation), colostomy stenosis (15% in HD, 35% in Anorectal malformation), Skin excoriation (40% in HD, 25% in Anorectal malformation), Revision of colostomy (15% in HD, 12% in Anorectal malformation), colostomy bleeding almost same in both conditions 30%, Parastomal herniation, 5% in both conditions, colostomy wound infection were also recorded, Same in both conditions 5%. Conclusions: Consider the risks associated with a colostomy formation before undergoing surgery in both Hirschsprung's disease and anorectal malformation. complications can be excluded with careful surgery and proper nursing care.

Types and Levels of Colostomy in Children with Anorectal Malformation

Objective: Divided colostomy for anorectal management is often recommended due to reports of higher complications associated with loop colostomy. This study was conducted to compare outcomes and complications in colostomies in children with anorectal malformations according to type and level of colostomy.
 Materials and Methods: A retrospective study was performed in children with anorectal malformations who underwent a colostomy at Siriraj Hospital between December 2003 and June 2018.
 Results: Out of 167 patients, 159 had a loop colostomy while 8 had a divided colostomy. Overall complication rates were 33.3% for loop colostomy and 62.5% for divided colostomy (p = 0.100). Urinary tract infection was the most frequently encountered complication in both loop and divided colostomies, at 23.7% and 50%, respectively (p = 0.094). The prolapse rate in the loop colostomy group was 8.8 % and 0% in the divided colostomy group (p = 0.376). Overall complication rates with respect to location of stoma also did not differ (p = 0.706). Prolapse rates were 15.8 % in transverse colostomy and 7.1 % in sigmoid colostomy (p = 0.231). Overall complications rates of colostomy closure in loop and divided colostomy was 7.5% and 12.5%, respectively (p = 0.672). Non-inferiority was demonstrated by the differences in overall complications of loop and divided colostomy (p = 0.008).
 Conclusion: There was no difference in incidence of complications between type or location of colostomy performed in children with anorectal malformations. Loop colostomy was non-inferior to divided colostomy in respect to overall complications.

Results of Colostomy Use in Children with Anorectal Malformation

Introduction. Anorectal malformations in children are still one of the most challenging problems in pediatric coloproctology. The incidence of anorectal malformations in recent years has no tendency to decrease and, according to various authors, ranges from 1 in 4000-5000 live births. Most pediatric surgeons continue to adhere to the opinion about the advisability of preliminary colostomy and delayed proctoplasty at the age of 6-18 months or when the child reaches a certain body weight (8-10 kg.). They are motivating this tactic with the possibility of creating an optimal condition for performing a complex intervention, reducing anesthetic risk, avoiding technical errors. Objective is to improve treatment outcomes for anorectal malformations in children with prior colostomy. Materials and methods. The work is based on the results of treatment of 154 children with anorectal malformation, with preliminary colostomy in the clinic of the Tashkent Pediatric Medical Institute for the period from 2000 to 2020. Along with routine and general clinical examination methods, all children underwent: X-ray of the abdominal cavity, colostography, fistuloirrigography, excretory urography, cystography, ultrasound of the perineum (small pelvis), neurosonography (NSG) screening tests. Results. 154 (10*0%) children had colostomy as a palliative stage of treatment. Of these 117 (76%) children developed colostomy on the first day of life, with the development of intestinal obstruction. In 37 (24%) children, the formation of a colostomy was performed directly by us. 9 (5.8%) children as the first stage before primary radical correction with a high form of the defect and 10 (6.5%) children previously operated on and requiring re-corrective operations, 5 (3.2%) patients underwent colostomy after the development of complications in the early postoperative period. In 13 (8.5%) cases, colostomies were formed with identified concomitant anomalies and defects that clinically "dominated" over anorectal malformation. In 2 (5.4%), a double sigmastoma was imposed, in 2 (5.4%) a distal single-barreled sigmastoma, in 5 (13.5%) the Hartmann type terminal sigmastoma. Conclusion. The use of colostomy in children with anorectal malformation made it possible to carry out the necessary surgical tactics in a timely and differentiated manner. To reduce the frequency, nature of complications and early disability, to improve the quality of life and social adaptation of patients.

SHORT TERM OUTCOME OF DIVERSION LOOP COLOSTOMY IN CHILDREN OF ANORECTAL MALFORMATION.

Purpose: Colostomy for patients with anorectal malformations decompresses an obstructed colon, avoids fecal contamination of the urinary tract, and protects a future perineal operation. The procedure is associated with several signicant complications. Objective: To study relation of various demographic factors, clinical features, complications and patient related factors with outcomes. Methods-All necessary data of these 50 patients were obtained from case sheets and attendants of patients admitted in SNCU, NICU and wards of department of paediatrics and surgery. All the details (demographic, patients related, surgery) of patient was lled in predesigned structured proforma. Results- More than half of babies were males (68%). The male to female ratio was 2.1:1. The mean weight at post-operative 7 days was 4.74±0.21 kgs which increased to 5.19±0.41 kgs at post-operative 1 month, 5.73±0.88 kgs at post-operative 2 months and 6.28±0.6 kgs at post op 3 months. There was signicant (p=0.001) increase in weight from post-operative 7 days to postoperative 1 month, 2 months and 3 months. Peri stomal skin excoriation was seen in 8% at post-operative 7 day, 14% at postoperative 1 month, 12% at 2 months and 4% at 3 months. Stomal prolapse was seen in 2% patients at post-operative 7 days and in 4% patients at 1 month & 2 months and became nil at 3 months post-operatively. There was signicant (p=0.001) difference in weight gain from 7 days to 3 months post-operative between groups of age <30 days (1.67±0.33 kgs) and ≥30 days (1.08±0.65 kgs). Conclusion- Minimal post-operative complications of diversion loop colostomy in children of anorectal malformation and hence we can conclude that loop colostomy is safe in patients with anorectal malformations. we recommend, a study with a large sample size and longer duration of follow up, needs to be done to have a more effective and rationale conclusion.

P0696 / #465: WHEN DIVERTING COLOSTOMY PERFORM TO CRITICAL ILLNES FOR SEVERE PERIANAL OPEN WOUNDS?

Aims & Objectives: The aim of the present study was to analyze the outcome after performing a diversion colostomy in children with severe perianal lesion. Methods: We are presenting to case series whose diverting colostomy was opened for large perianal open wounds and sepsis. Results: Our first patient was 6-month girl whose diagnosed with meningococcemia had extensive necrotizing wounds in the perianal region, a colostomy performed (on the 40th day hospitalization) to prevent stool passage and skin irritation. In the follow-up of the patient, wound healing was observed and no additional problem was observed. It was learned that the patient’s colostomy was closed in the 5th month. Second patient was 7-moth girl, also she was diagnosed meningococcemia along with severe purpura fulminans then extensive necrotizing wounds in the perianal region, a colostomy performed (on the 23th day of admission). The patient is still in our hospital and has colostomy. The patient was in good general condition. Third patient’s disorder was dilated cardiomopathy and then total artificial heart support implanted because of failure. He had extensive sacral decubitus ulcer and a colostomy performed (on the 58th day of hospitalization). After healing of the patient’s wound, colostomy was closed in the 10th month hospitalization. We achieved successful results in 3 patients.Conclusions: In conclusion, the present study is the first to case series the use of diverting colostomy method for critically ill children sever and large open perianal wounds. Colostomy may be good treatment option for perineal severe tissue lost.

Evaluation of Complications of Colostomy in Children

Background and Aims This study aimed to evaluate the complications of colostomy and its management in children at tertiary care centre.Methods This descriptive observational study was conducted over a period of four years from February 2017 to January 2021. All the children below five years of age who underwent colostomy were included in the study. The demographic and clinical data on age at colostomy procedure sex clinical details indication for colostomy site type of colostomy complications of colostomy procedure morbidity and mortality due to the colostomy procedure were collected and analyzed.Results During our study period 38 children underwent colostomy procedure who had fulfilled our inclusion criteria. Among 38 children 23 60.5 children were of High Anorectal Malformations and 15 39.5 children were of Hirschsprungrsquos disease. Children who had anorectal malformation were younger and underwent colostomy in neonatal period mean 3 days plusmn 2.41 compared to those who had Hirschsprungrsquos disease who underwent colostomy procedure between one month to five years mean 6.8 months plusmn 3.55. There were 26 60.4 male and 12 31.6 female children with male to female ratio of 2.21. Complications related to colostomy procedure were seen in 28 73.7 children. Early complications like wound infection superficial wound dehiscence stoma necrosis and bleeding stoma were seen in 13 34.2 children whereas late complications like Peristomal skin excoriation Colostomy retraction Colostomy stenosis Colostomy prolapse Para colostomy hernia were seen in 15 39.5 children. Majority of complications 17 44.7 were seen in end colostomy made in Hirschsprungrsquos disease children. Systemic complications like sepsis pneumonitis was seen in early post-operative period in 8 21.1 children among which two 5.3 children succumbed due to severe sepsis and respiratory failure.Conclusions Although colostomy complications are common in children majority of the colostomy complications are prevented or minimized by good surgical technique education of parents on colostomy care and hygiene.

Indications and complications of colostomy in newborn: our experience

Background: The aim of the present study was to evaluate the indications, complications and outcome of colostomy in newborn patients.Methods: This is a descriptive, retrospective study carried out in the Department of Pediatric surgery, Gandhi Medical College Bhopal to evaluate acceptance and outcome of colostomy in newborn over a one year period from March 2018 to March 2019. All newborn with diagnosis of anorectal malformation, Hirshsprungs disease and other emergency conditions underwent transverse loop colostomy by expert and trained pediatric surgeon.Results: Out of 40 patients operated complications of colostomy was seen in 18 (45%) patients. Most common complication was skin excoriation in 08 patients (20%), bleeding from stoma site in 02 (05%) cases. Stoma prolapse occurred in 02 (05%) patients. Wound infection, dehiscence, stomal stenosis and parastomal hernia was seen in one patient each 2 (2.5%). 2 (0.5%) patient died due to multiple congenital anomalies.Conclusions: Colostomy in children is associated with significant morbidity in developing country. To minimize these problems, the pediatric surgeon should focus on the management and early closure of a colostomy.

Colostomy in children on chronic peritoneal dialysis

This study aimed to evaluate outcome of children on chronic peritoneal dialysis (PD) with a concurrent colostomy. Patients were identified through the International Pediatric Peritoneal Dialysis Network (IPPN) registry. Matched controls were randomly selected from the registry. Data were collected through the IPPN database and a survey disseminated to all participating sites. Fifteen centers reported 20 children who received chronic PD with a co-existing colostomy. The most common cause of end stage kidney disease was congenital anomalies of the kidney and urinary tract (n = 16, 80%). The main reason for colostomy placement was anorectal malformation (n = 13, 65%). The median age at colostomy creation and PD catheter (PDC) insertion were 0.1 (IQR, 0-2.2) and 2.8 (IQR 0.2-18.8) months, respectively. The colostomies and PDCs were present together for a median 18 (IQR, 4.9-35.8) months. The median age at PDC placement in 46 controls was 3.4 (IQR, 0.2-7.4) months of age. Fourteen patients (70%) developed 39 episodes of peritonitis. The annualized peritonitis rate was significantly higher in the colostomy group (1.13 vs. 0.70 episodes per patient year; p = 0.02). Predominant causative microorganisms were Staphylococcus aureus (15%) and Pseudomonas aeruginosa (13%). There were 12 exit site infection (ESI) episodes reported exclusively in colostomy patients. Seven colostomy children (35%) died during their course of PD, in two cases due to peritonitis. Although feasible in children with a colostomy, chronic PD is associated with an increased risk of peritonitis and mortality. Continued efforts to reduce infection risk for this complex patient population are essential.

Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

IntroductionThe protrusion of the bowel through the stoma in a colostomy is one of thecommon complications of colostomy. Though it rarely gets secondarilycomplicated, it causes significant morbidity by virtue of the increasing bowel massoutside. The predisposing factors and progression in children are not well reportedin our region.AimTo evaluate the characteristics and occurrence of colostomy prolapse in childrenand to identify any factors predisposing to this complication in our practice.Patients and MethodsThis is a five year prospective study of paediatric colostomy in the authors’ servicebetween March 2013 and April 2018. Patients were categorized into those thatdeveloped prolapse (Pro group), and those that did not (Non Pro group). Othervariables investigated were gender, age at creation of colostomy, indication, type,and duration of colostomy, presence of raised intra abdominal pressure. Statisticswas with SPSS 21.ResultsTwenty seven (28.4%) of 95 children who had colostomy during the study perioddeveloped prolapsed. Prolapse occurred more in patients who had their colostomyat a relatively older age. There was a positive association of prolapse andHirschsprungs disease but no association with the gender or duration of stoma.ConclusionColostomy prolapse is a common complication seen in our practice. Cases ofneglected Hirschsprungs disease in children have increased risk of thiscomplication. Extra caution is therefore needed in forming colostomy in this groupof patients.

To Split or Not to Split: Colostomy Complications for Anorectal Malformations or Hirschsprung Disease: A Single Center Experience and a Systematic Review of the Literature

The aim of this article is to identify the ideal type and location of colostomy in children with colorectal disease. A retrospective case study of children with an anorectal malformation who received a colostomy, born between January 1990 and July 2012. Furthermore, a systematic literature search on colostomies in neonates with an anorectal malformation or Hirschsprung disease. Colostomies were classified as loop or split colostomies in the transverse or sigmoid colon. Outcome measures were mortality and complications such as prolapse, technical difficulties with the reconstruction, urinary tract infections, and others. The mortality rate in the 180 children with anorectal malformation was 6%, and none of them were directly related to stoma formation or closure. The overall complication rate was 23% and the specific rates for the two types of procedures and the two locations of the colostomy did not differ (p = 0.389 and p = 0.667, respectively). All prolapses (n = 22) occurred in loop colostomies in the transverse colon. One colostomy required revision because of insufficient length for the reconstruction. Urinary tract infections were not documented. A total of eight studies were included in the systematic review (1982-2011; 2,954 patients). Mortality ranged between 0.1 and 11%. Loop colostomies had more complications than split colostomies (63 vs. 45%; p = 0.007), mainly prolapse (18 vs. 6%; p < 0.001). Overall complication rate differed between transverse en sigmoid colostomies (62 vs. 51%, p = 0.006), and prolapse occurred more often in the transverse colon (23 vs. 7%; p < 0.001). Revision because of insufficient length during the reconstruction was needed in 0 to 6%. Two studies reported on urinary tract infections which are as follows: One showed no difference between loop or split colostomies, whereas the other showed frequent episodes of urinary tract infections in 64% of the loop colostomies. The complication to be avoided in transverse colostomies is prolapse and the surgical technique should be modified accordingly. The procedure of split sigmoid colostomy is meticulous, and the risk of insufficient length for the reconstruction remains.

Skin bridge versus rod colostomy in children - comparison between complications.

Due to economic problems, sigmoid loop colostomy using glass rod may cause problems for our patients for finding glass rod and several visits. The aim of the study was to compare rod versus skin bridge colostomy. In this study, 42 cases who are candidate for colostomy were included. Cases were randomly placed in skin bridge and rod colostomy group. Independent sample t-test and Chi-square were used for comparison. SPSS version 16.0 (SPSS Inc, Chicago, IL, USA) was used for analysis. Of 42 cases, 20 were male and 22 were female. Hirschsprung's disease was the indication of colostomy in 33 cases. In nine cases, imperforate anus was the indication of colostomy. Mean time of surgery was 79.4 and 82.5 minute for the rod and skin bridge group respectively (P>0.05). Retraction was seen in 2 case of rod group, and no case of skin bridge group. Prolapse was seen in 2 (9.5%) case of rod group and 1(4.7%) case in skin bridge. There were no reports of necrosis, stenosis, and hernia in both groups. In the skin bridge group the rates of complications were lower but the groups are too small for statistical analysis. Colostomy with a skin bridge method may decrease number of revision and expenses and may be appropriate option. Sigmoid loop colostomy using skin bridge flap may be appropriate choice in developing country. Another study with more samples is recommended to better comparison of Skin Bridge versus rod colostomy.

Primary perineal surgeries for the low and intermediate anorectal anomalies: 5‐year results in a developing country

Aim: The late presentation of clinically unstable children with anorectal anomaly requires the creation of a prior colostomy. The objective of the present study was to examine the feasibility and applicability of primary perineal surgeries for low and intermediate anorectal anomalies without a prior colostomy.Methods: A 5‐year experience with consecutive cases of children that had primary perineal surgeries for low/intermediate anorectal anomaly at the University of Benin Teaching Hospital, Benin City, Nigeria, between January 2003 and December 2007.Results: A total of 29 children aged between 1 day and 3 years (mean 5.4 months ± 2.7), comprising 17 males and 12 females with a male/female ratio of 1.4:1 had primary perineal surgeries for low 19 (65.5%) and intermediate 10 (34.5%) anorectal anomalies. They accounted for 15.6% of children who underwent gastrointestinal operations, and diagnosis was mainly clinical in the majority of them. Transposition anorectoplasty done in 19 (65.5%) children was the commonest procedure, followed by anterior perineal anorectal pullthrough in six (20.7%) and cutback anoplasty in four (13.8%). Anal stenosis which responded to serial dilatation was the main complication and it was statistically significant for the intermediate group compared to the low group (P &lt; 0.0002). More children among the low group had recurrent constipation, although no significant statistical difference was observed when this was compared (P &lt; 0.6451). Overall, 27 (93.1%) children, comprising 18 low and nine intermediate lesions, were successfully managed whereas one (3.4%) child with intermediate lesion had revision surgery with one (3.4%) mortality recorded due to sepsis.Conclusion: Primary perineal surgeries without a prior colostomy in children with low and intermediate anorectal anomaly were feasible, applicable and should be used in our setting.

Colostomy in children--an evaluation of acceptance among mothers and caregivers in a developing country.

Colostomy is a common procedure performed in children, mostly for anorectal malformation and Hirschsprung's disease. However, acceptance by parents in developing countries is thought to be poor. A prospective evaluation was done to determine the acceptability of colostomy among parents and caregivers, and their attitude towards colostomy in their children. During the period January 1999 - January 2004 a structured questionnaire was administered to 57 parents and caregivers of children with colostomies (41 boys and 16 girls). The indication for colostomy was anorectal malformation in 28 children and Hirschsprung's disease in 29. The length of time the children had the colostomy ranged from 3 weeks to 8 years. Forty-four respondents (77%) found the colostomy and its management acceptable. Thirteen (23%) found the colostomy unacceptable, mainly because of a feeling of social isolation. Problems the respondents complained of included disturbing smell (17, 30%), frequent change of the cloth napkin used as colostomy appliance (15, 26%) and intermittent bleeding from the stoma (4, 7%). Colostomy in children is acceptable to most parents in our environment. Although some parents found it unacceptable, adequate explanation and counselling may modify their view.

Outcome of the antegrade colonic enema procedure in children with chronic constipation

Background: Chronic constipation and fecal incontinence in children related to pelvic trauma, congenital anomalies, or malignancy will eventually lead to significant social and psychologic stress. Maximal medical treatment (daily enemas and laxatives) can also be difficult to maintain in many children. Methods: At our children’s hospital, 11 children with chronic constipation or fecal incontinence or both underwent the antegrade colonic enema (ACE) procedure. The operation involved constructing a conduit into the cecum using either the appendix (n = 8) or a “pseudo-appendix” created from a cecal flap (n = 3). We report our surgical results. Results: Mean child age was 9.6 (5 to 18) years. With a mean follow-up of 14 (6 to 24) months, 10 of the children (91%) had significant improvement and 7 children (64%) are completely clean with no soiling and controlled bowel movements after irrigation. Conclusions: Regular colonic lavage after the ACE procedure allows children with chronic constipation and fecal incontinence to regain normal bowel habits and a markedly improved lifestyle. This procedure should be considered before colostomy in children and adults for the treatment of fecal incontinence from a variety of causes.

Simple method of dilatation for strictured colostomy in children.

A simple, safe method for dilatation of strictured colostomies with the Cottle nasal speculum as an alternative to classical Hegar's dilators is proposed.

Proximal end transverse colostomy in children. A method to avoid colostomy prolapse in Hirschsprung's disease.

A method of end transverse colostomy which avoids colostomy prolapse in Hirschsprung's disease is described.