Type Of Colostomy Research Articles

The clarification of the concept of colostomy nursing care in ostomy care centers: A concept analysis through Walker and Avant's method.

Specialist nurses need to have an accurate understanding of colostomy care-related concepts to provide care. Although patients with different types of ostomy have different types of needs, terms such as ostomy care, colostomy care, and ileostomy nursing are interchangeably used. Moreover, there are limited concept analysis studies into the concept of colostomy nursing care (CNC) in ostomy care centers (OCCs). The aim of this study was to analyze and clarify the concept of CNC in outpatient OCCs. This was a concept analysis study. This concept analysis was conducted using Walker and Avant's eight-step method. The online databases were searched until 2022 to retrieve documents on CNC. Finally, 35 articles and four books were included in the analysis, the defining attributes, antecedents, and consequences of the concepts were determined, and model and additional cases as well as empirical referents were presented. The defining attributes of CNC in OCCs are the development of professional role, participatory practice and interdisciplinary care, selection of the best clinical procedures, care based on patient education, and patient rehabilitation. The antecedents of the concept are nurse-related antecedents, patient- and family-related antecedents, environmental antecedents, and professional rules and regulations. Its consequences are patients' and families' greater care-related knowledge, improvement of nurses' care quality, patient autonomy, and self-efficacy. The concept of CNC in OCCs can be defined as "a continuous and coherent care based on knowledge, skill, expertise, experience, and colostomy type which uses interdisciplinary collaboration and the best available evidence in order to select and provide the best services according to patients' and families' culture and background, fulfill patients' physical, mental, sexual, social, and spiritual needs, and timely refer patients to specialists, with the ultimate goal of improving patient autonomy and facilitating their return to normal life."

Quality of Life among Colostomy Patients in Najran, Saudi Arabia

Abstract Background: Colostomy surgery significantly impacts the quality of life (QoL) of patients, encompassing physical, psychological, social, and spiritual well-being. This study aimed to assess QoL among colostomy patients in Najran, Saudi Arabia, using the City of Hope Quality of Life-Ostomy Questionnaire (COH-QOL-OQ) Arabic version. Methodology: A cross-sectional study was conducted with 73 colostomy patients at King Khaled Hospital. Demographic characteristics, colostomy-related factors, and QoL scores were analyzed using the descriptive statistics and analysis of variance. Results: Participants aged 18–30 years reported higher physical QoL scores than older age groups. Marital status before colostomy, educational level, and body mass index significantly influenced psychological, social, and spiritual QoL domains. Fecal incontinence as a reason for colostomy was associated with lower psychological well-being scores. Notably, participants with “I do not know” as the type of colostomy reported higher spiritual QoL scores. The findings emphasize the intricate relationship between demographic and colostomy-related factors and QoL domains. These insights underscore the need for comprehensive care strategies, acknowledging the multidimensional nature of patients’ well-being. Conclusion: This study advances our understanding of QoL among colostomy patients in Saudi Arabia, offering insights for health-care professionals to develop more holistic care approaches. The findings illuminate the significance of multidimensional factors in shaping patients’ overall well-being, thus contributing to enhanced patient-centered care and improved QoL outcomes.

Retrospective analysis of factors associated with emergency colostomy: an institutional experience

<p class="abstract"><strong>Background:</strong> Colostomy is one of the commonest lifesaving procedures done worldwide with an intention of either decompression of an obstructed colon or diversion of stool. This study tries to assess the pattern of emergency colostomy and factors associated with its complication in adult patients at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia.</p><p class="abstract"><strong>Methods:</strong> Retrospective reviews of charts were done of all adult patients who underwent colostomy procedure from December 1, 2016 to May 30, 2019. </p><p class="abstract"><strong>Results:</strong> There were 149 adult patients that underwent colostomy procedure in the study period and the majorities were male (83.2%). Majority of the procedures were done for indication of LBO secondary gangrenous sigmoid volvulus (49%). The most common comorbidity identified were renal disease (5%) and diabetes mellitus (3%). All patients who presented with gangrenous sigmoid volvulus underwent end colostomy procedure and 16.8% of them died. Generally, 69 patients among 149 (46.3%) developed certain type of complication. Presence of complication was significantly associated with increased chance of death by eight times than those who had no complication after the procedure. End colostomy was significantly associated with development of complication when compared to loop colostomy. Among the study participants 87.9% of them were discharged improved. The main cause of death was multi organ failure secondary to septic shock, which accounted to 52.9% of all deaths.</p><p class="abstract"><strong>Conclusions:</strong> Gangrenous sigmoid volvulus, colorectal cancer and trauma were leading indications for colostomy. Presence of complication and type of colostomy were factors significantly associated with outcome.</p>

Perfil de idosos com estomias em uma região de Minas Gerais

Objetivo: Descrever o perfil de pessoas idosas com estomias de uma microrregião de saúde do Centro-Oeste mineiro. Método: Estudo descritivo, transversal e documental realizado por meio da análise de prontuários utilizados para cadastro de pessoas com estomias. Resultados: A amostra foi composta por 85 idosos, com idade média de 73 anos, prevalência do sexo feminino (55,3%), casados (55,3%), ensino fundamental completo ou não (78,8%); 75,3% eram aposentados e com renda de até dois salários mí­nimos (87%). Observou-se predominância do tipo colostomia (72,9%) em caráter definitivo (76,5%), por câncer (84,7%) e confeccionada há mais de 3 anos (57%). Tendo como dependência total ou parcial (49,4%) para a realização do autocuidado cotidiano. Conclusão: Observou-se que os idosos com estomias de um SASPO de uma microrregião de saúde do Centro Oeste Mineiro eram, em sua maioria, do sexo feminino, casados, com baixo grau de instrução, aposentados e com renda igual a dois salários mí­nimos, com predominância de estomia do tipo colostomia, definitiva, por câncer e confeccionada há mais de 3 anos. Foi possí­vel conhecer o perfil dos idosos que convivem com a estomia, contribuindo para que os profissionais de saúde possam planejar sua assistência buscando proporcionar melhor qualidade de vida aos idosos com estomia.

Vesicoureteral reflux increases the risk of urinary tract infection prior to corrective surgery in newborn males with anorectal malformation.

The ideal colostomy type indicated for patients with anorectal malformation (ARM) is disputed. The aim of this study was to analyze the clinical factors associated with urinary tract infection (UTI) prior to corrective surgery in male ARM without perineal fistula having undergone diverting enterostomy. A retrospective review of patients diagnosed with ARM and surgically managed at our center from January 2011 to December 2019 was performed. Logistic regression was used to analyze the association between clinical factors and UTI. Eighty boys with ARM without perineal fistula underwent diverting enterostomy and subsequent corrective surgery via laparoscopic-assisted anorectal pull-through. A sigmoid loop colostomy was most often performed (70 patients, 87.5%). Twenty-nine patients (36.3%) were diagnosed with vesicoureteral reflux (VUR), including 14 (48.3%) with febrile UTIs. Six patients had other concomitant genitourinary anomalies excluding VUR. Multivariate logistic regression analysis revealed the presence of VUR as the only independent factor associated with the occurrence of febrile UTI (OR 17.3, 95% CI 3.51-85.26, p < 0.001). The development of UTI in newborn males with ARM is associated with the presence of VUR, regardless of stoma type. Voiding cystourethrography should be considered in patients with ARM for early diagnosis of VUR and subsequent antibiotic prophylaxis.

Selected Factors Related to Adaptation among Colorectal Cancer Older Adults with Colostomy

OBJECTIVES: To examine the adaptation among colorectal cancer older adults with colostomy and the correlations between selected factors and adaptation to colostomy. MATERIAL AND METHODS: This correlational descriptive study included 100 older adults with colorectal cancer who had undergone colostomy for one month after being discharged from the hospital. Five questionnaires were used to collect the data. Data were analyzed using descriptive statistics, Pearson’s product moment statistics, Spearman’s rank order statistics, Kruskal-Wallis statistics, Independent t-test statistics, and One-way ANOVA statistics. RESULT: The majority of participants were young-old adults and their age ranged from 60-88 years old (70.82 ± 8.23). Most participants had a high score of adaptation (153.98 ± 17.04). Ostomy self-care ability and adaptation had a moderate level of correlation with statistical significance of (r = 0.37, p &lt; 0.05). However, age group, functional ability, the type of colostomy, complications related to the colostomy, and social support had no statistically significant correlations with adaptation. CONCLUSION: The findings from this study benefit nurses and healthcare providers to understand adaptation among colorectal cancer older adults with a colostomy. These findings can be used as information to assess the ability to perform ostomy self-care in colorectal cancer older adults with a colostomy. However, promoting ostomy self-care is a concern in the old-old adults (aged 85 and above). They might need help from caregivers.

A clinical study of colostomies in infancy and childhood in a tertiary centre

Background: The word stoma is derived from the Greek word stoma meaning mouth or opening. Intestinal stoma are surgically created opening that connect part of gastro-intestinal tract with the anterior abdominal wall. The use of various types of colostomies can be lifesaving. Since at our centre we regularly perform colostomies in treatment of various conditions in paediatric age group, this clinical study was undertaken.Methods: This clinical study was conducted in the Department of General Surgery at College of Medicine and JNM Hospital, Nadia. The study was conducted during the period from August 2018 to July 2019. The patients aged day 1 to 12 years were admitted.Results: In the one year study period, 33 cases of paediatric colostomies were performed. 17 (51.5%) were male and 16 (48.5%) were females. Majority of the patients at the time of colostomy were in the early neonatal period. A total of 22 (66.6%) cases underwent colostomy at our hospital and 11 (33.4%) patients had undergone colostomy elsewhere. Majority of the cases who had undergone colostomy were of sigmoid loop variety and 9 patients (27.3%) had transverse loop colostomy. A total of 12 patients (36.36%) suffered post colostomy major complications needing attention.Conclusions: The child is a socio-psycho-biological unit and colostomy leads to substantial psychological trauma for the child and parents. Careful examination is the key to diagnosis and initial management. An appropriately indicated, properly constructed temporary stoma is frequently unavoidable and lifesaving.

Clinical and sociodemographic analysis of people with ostomies: a cross-sectional study

Objectives: To analyze clinical and sociodemographic aspects of people with ostomies in the state of Minas Gerais. Methods: A cross- sectional study was conducted in 54 municipalities in 2016. Data were collected from 418 people with ostomies, registered from a structured questionnaire. Descriptive data analysis, the Pearson chi-square test and the Bonferroni correction were performed. Results: The majority of people with ostomies are elderly, male, have low schooling and low wage income. Colorectal malignant neoplasia was the main cause and 14.3% were treated with chemotherapy. Part of the ostomies is of the regular standing permanent colostomy type. The main complication highlighted is dermatitis, and 45.5% are not able to develop self-care. The type of ostomy was significantly associated with stomatal permanence, marital status and income (p &lt;0.05).Conclusion: People with ostomies need assistance related to self-care orientation, prevention and treatment of their complications.

The type of stoma matters-morbidity in patients with obstructing colorectal cancer.

A loop colostomy may reduce the risk of severe intraabdominal complications in patients with obstructing colorectal cancer compared to an end colostomy. The aim of this study was to relate complications to the type of stoma, and a secondary aim was to evaluate whether the type of colostomy had an impact on time until oncological/surgical treatment. All patients who underwent surgery and received a deviating colostomy due to obstructing colorectal cancer between January 2011 and December 2015 in five Swedish hospitals in Region Västra Götaland were included (n = 289). Patient charts were reviewed retrospectively. Patients alive in the end of 2016 were contacted and were sent a questionnaire including questions about stoma function and health-related quality of life. Some 289 patients were included; 147 received an end colostomy and 140 a loop colostomy. Two patients were excluded from the analysis due to missing data. There was no difference in complications at 90days between the two groups, 44% (end colostomy) and 54% (loop colostomy) (odds ratio: 0.83 (95% CI: 0.49; 1.41). Time to start of treatment was similar in both groups. Patients with a loop colostomy had significantly higher stoma-related morbidity with retraction, prolapse, leakage and bandaging problems. No differences in quality of life were found. The hypothesis that a loop colostomy reduced complications could not be confirmed. An end colostomy should be the first choice in these patients particularly in patients who will have their colostomy for the remainder of their life to reduce stoma-related symptoms.

Impact of in Effect of Instructional booklet on the knowledge, attitude, problems faced and coping strategies adopted by colostomy patients in selected hospitals of Delhi

AimThe main aim of the study was to evaluate effectiveness of the instructional booklet (IB) on colostomy patients. Material and methodsQuasi experimental approach was used on 200 patients drawn from two tertiary care hospitals of Delhi. Intervention: instructional booklet on colostomy care(IB) for colostomy care was developed that included: knowledge of disease related to colorectal cancer, Colostomy care, Care of appliance, Diet, Self-care, Problems arising from stoma. ResultsDemo graphic characteristics and clinical profile of patients were similar in control and experimental groups except gender, age, Education, monthly income and type of colostomy. Information booklet significantly enhanced knowledge, attitude, and coping and reduced physical and psychosocial problems. The acceptability and utility of informational booklet by patients was very high. ConclusionInformation booklet was found to be effective in enhancing knowledge, developing positive attitude, decreasing physical and psychosocial problems and adopting better coping. ImplicationsAll the colostomy patients and their care givers need to be trained on colostomy care prior to their discharge after surgery so that they can independently take care of themselves.

Colostomy Closure in Pediatric Age Group: Analysis Of Out Come in Single Center Experience

Background: Closure colostomy is a common procedure in the pediatric surgical practice, considered a major one because it involves anastomosis of the large bowel, and requires strict bowel preparation and prophylactic antibiotics. It’s the last event in the management of some pediatric surgical conditions, as Hirschsprung’s disease and anorectal malformations.Objectives: To evaluate the complications of colostomy closure in pediatric patients.Patients and methods: A total of 106 patients underwent colostomy closure were enrolled in this prospective study conducted in Welfare Teaching Hospital in Medical City Complex, from October 2015 to January 2017, were reviewed looking for complications following closure colostomy. Data were collected including age, gender, indication of colostomy, type and location of colostomy, presence of stoma complication, and presence of associated anomalies. Details of colostomy closure, including pre-operative, intra-operative and post-operative variables were recorded.Results: Of 106 patients included, there were 38(35.8%) females and 68(64.2%) males, with an average age of 2.4 years. Indications for colostomy were Hirschsprung’s disease 58(54.7%) and anorectal malformations 48(45.3%). The site of colostomy was transverse colon 54(50.9%), and sigmoid colon 52(49.1%). The type of colostomy was divided 8(7.5%) and loop 98(92.5%). Forty-eight patients (45.3%) developed complications; the most common being wound infection 30 (28.3%), followed by fecal fistula 6 (5.7%), wound dehiscence 4 (3.8%), adhesive intestinal obstrution 4 (3.8%) and incisional hernia 4 (3.8%).Conclusion: Closure colostomy is a high morbidity procedure. With morbidity rate of 45.3%, the highest complications were wound infection.Keywords: Hirschsprung’s disease (HD), Anorectal malformation (AM)&#x0D; غلق كولوستومي : تحليل النتائج في مركز منفرد&#x0D; الاستاذ المساعد الدكتور حسن كريم كاطع &#x0D; خلفية: عملية غلق فغر القولون هي عملية شائعة في مجال عمل جراحة الاطفال، وتعتير عملية كبرى لانها تتضمن ربط الامعاء الغليضة ببعضها, وتحتاج قبلها الى تحضير للامعاء مع مضادات حيوية وقائية. وهي الحدث الاخير في علاج بعض حالات جراحة الاطفال، والتي تتطلب اجراء عملية فغر القولون كخطوة اولى في علاجها, مثل شلل القولون الولادي والتشوهات الشرجية الولادية &#x0D; هدف الدراسة: لتحديد مضاعفات عملية غلق فغر القولون.&#x0D; المرضى وطريقة العمل: في دراسة مستقبلية اقيمت في مستشفى حماية الاطفال/مدينة الطب ، والتي شملت 106 مريض خضعوا لعملية غلق فغر القولون للفترة من تشرين الاول 2015 الى كانون الثاني 2017، لغرض البحث عن حدوث مضاعفات بعد هذه العملية. البيانات المدروسة جمعت من ملفات دخول المرضى فيما يخص العمر، الجنس،الحالة الموجبة لعملية فغر القولون، نوع وموقع فغر القولون، وجود مضاعفات لفغر القولون، وجود تشوهات وامراض مصاحبة للتشخيص الاولي للمريض، بالاضافة الى تفاصيل عملية غلق فغر القولون فيما يخصمتغيرات قبل ، اثناء و بعد العملية. &#x0D; النتائج: من بين 106 مريض تمت دراسة 38 انثى و 68 ذكر، مع معدل عمر 2،4 سنة، موجبات عملية فغر القولون كانت 58 حالة شلل القولون الولادي، 48 حالة تشوهات الشرج الولادية، موقع فغر القولون كان القولون المستعرض في 54 حالة، و القولون السيني في 52 حالة، نوع فغر القولون كان فغر قولون منفصل في 8 حالات و فغر قولون عقدي في 98 حالة. ثمانية واربعون مريضا عانوا من مضاعفات، اكثرها شيوعا كان التهاب الجرح في 30 حالة بنسة 28،3%، تبعها ناسور الامعاء في 6 حالات بنسة 5،7%، تفزر الجرح في 4 حالات بنسبة 3،8%، انسداد الامعاء التلاصقي في 4 حالات بنسبة 3،8% و الفتق الجراحي في 4 حالات بنسبة 3،8% &#x0D; الاستنتاج: عملية غلق فغر القولون هي عملية ذات نسبة مضاعفات عالية، اكثرها كان التهاب الجرح. لم تسجل وفيات خلال الدراسة. وجد ان نسبة المضاعفات مع مرض شلل القولون الولادي كانت اكثر من حالات تشوهات الشرج الولادية. فغر القولون العقدي للقولون المستعرض سجل خطورة عالية. كما وجد ان تحضير الامعاء(غسل الامعاء) قبل عملية غلق فغر القولون مع اعطاء المضادات الحيوية الوقائية تقلل المضاعفات بعد العملية. من العوامل المسجلة والمأثرة على تكوين المخاطر هو عدم توافق حجم الامعاء اثناء غلق القولون. كما وجد ان خياطة الامعاء بطبقة واحدة اثناء عملية الغلق تعطي نتائج افضل. &#x0D; مفتاح الكلمات: HD- شلل القولون, AR M, تشوة المقعد والمستقيم

Colostomy Closure in Pediatric Age Group: Analysis Of Out Come in Single Center Exp erience

Background: Closure colostomy is a common procedure in the pediatric surgical practice, considered a major one because it involves anastomosis of the large bowel, and requires strict bowel preparation and prophylactic antibiotics. It’s the last event in the management of some pediatric surgical conditions, as Hirschsprung’s disease and anorectal malformations.Objectives: To evaluate the complications of colostomy closure in pediatric patients.Patients and methods: A total of 106 patients underwent colostomy closure were enrolled in this prospective study conducted in Welfare Teaching Hospital in Medical City Complex, from October 2015 to January 2017, were reviewed looking for complications following closure colostomy. Data were collected including age, gender, indication of colostomy, type and location of colostomy, presence of stoma complication, and presence of associated anomalies. Details of colostomy closure, including pre-operative, intra-operative and post-operative variables were recorded.Results: Of 106 patients included, there were 38(35.8%) females and 68(64.2%) males, with an average age of 2.4 years. Indications for colostomy were Hirschsprung’s disease 58(54.7%) and anorectal malformations 48(45.3%). The site of colostomy was transverse colon 54(50.9%), and sigmoid colon 52(49.1%). The type of colostomy was divided 8(7.5%) and loop 98(92.5%). Forty-eight patients (45.3%) developed complications; the most common being wound infection 30 (28.3%), followed by fecal fistula 6 (5.7%), wound dehiscence 4 (3.8%), adhesive intestinal obstrution 4 (3.8%) and incisional hernia 4 (3.8%).Conclusion: Closure colostomy is a high morbidity procedure. With morbidity rate of 45.3%, the highest complications were wound infection.Keywords: Hirschsprung’s disease (HD), Anorectal malformation (AM)&#x0D; غ

Childhood Colostomy and Its Complications in Aba, Nigeria

Background: Colostomy in paediatric surgical practise is still important for decompression in colonic bowel obstruction, trauma to the colon and perineum in children. Objective: To determine the indications and complications arising from childhood colostomy in Aba, Nigeria. Methods: Proforma was opened for consecutive children that had colostomy at the Abia State University Teaching Hospital Aba from October 2016 to November 2017. Data collected include demography, indication for colostomy, Type of colostomy, complications arising from the procedure and outcome. SPSS version 17 was used to asses for proportions and percentages. Results: Thirty children had colostomy during the 14 months period. There were 20 males and 10 females (male to female 2:1). Their ages ranges from 2 days to 2 years [Mean 6.5months]. The main indications for colostomy were high anorectal malformation in 15patients (50%), Hirschsprung’s disease 10 patients (33%) and perineal trauma in 5 patients (17%). Complication occurred in 10 patients (33%). The most common complications were skin excoriations in 7 patients, surgical site infection and stoma bleeding. Four patients died following severe co-morbidities. Conclusion: Colostomy is still needed for decompression in childhood colonic intestinal obstruction. However, morbidity is still high due to lack of stoma bags and stoma care nurses.

Left transverse loop colostomy versus high sigmoid loop colostomy for high-type anorectal malformations: Early outcome analysis

Background: High sigmoid (divided) colostomy has been recommended by various studies for the management of high-type anorectal malformation (ARM). It is postulated to be associated with fewer complications. Aims: To compare the complications related to left transverse loop colostomy and high sigmoid loop colostomy done in male patients with high-type ARM and share our experience. Materials and Methods: A prospective study on all male neonates admitted with high-type ARM at our high-volume tertiary care institute from January 2014 to March 2016 was carried out. The patients were randomized and divided into two groups (group A: left transverse loop colostomy and group B: high sigmoid loop colostomy). The patient's clinical presentation, operative course, and complications were recorded. Results: Of 158 male neonates who were subjected to loop colostomy, 93 (58.9%) were in group A and 65 (41.1%) in group B. Mortality was higher in group B (16.9%) than group A (8.6%), but none directly related to the type of colostomy. Intraoperative complications (technical difficulties) such as difficulty in approaching the sigmoid colon with dilated small bowel loops and identifying the proximal and distal parts of sigmoid colon along with handling of the bowel (including serosal tears) were significantly more in group B (20%) than group A (1.07%) where transverse colon was easily exteriorized. The average time taken for the procedure, pericolostomy excoriation, and bowel obstruction was more in group B when compared with group A. Conclusion: Left transverse loop colostomy works well to relieve the obstruction and is less time-consuming, particularly with late presentation. We recommend left transverse loop colostomy in cases of high-type male ARM because of the ease of procedure and comparatively low complication rates.

Loop versus divided colostomy for the management of anorectal malformations: a systematic review and meta-analysis

BackgroundThe ideal colostomy type for patients with anorectal malformations (ARM) is undetermined. We performed a systematic review and meta-analysis of short-term complications comparing loop and divided colostomies. MethodsAfter review registration (PROSPERO: CRD42016036481), multiple databases were searched for comparative studies without language or date restrictions. Gray literature was sought. Complications investigated included stomal prolapse/hernia/retraction, wound infections, and urinary tract infections (UTIs). Two reviewers independently assessed study eligibility and the quality of included studies. Meta-analysis of selected complications was performed using Revman 5.3, with p<0.05 considered significant. ResultsTwenty-six studies were included, and four were multi-institutional. Reporting standards were highly variable. Studies scored between 6 and 9 of possible nine stars on the NOS. Overall, 3866 neonates with ARM were incorporated, in which 2241 loop colostomies and 1994 divided colostomies were reported. Of 10 studies reporting short-term complications, the overall rate was 27%. Meta-analysis demonstrated no significant difference in the incidence of UTIs, (OR: 2.55 [0.76, 8.58], p=0.12), while loop colostomies had a significantly higher prolapse rate (See figure). No publication bias was noted. ConclusionsA colostomy for patients with an ARM is a source of considerable morbidity. Divided colostomies reduce the risk of subsequent prolapse and may represent the preferred approach. Level of evidence3A

Predictors of morbidity in patients undergoing diverting colostomy for non-healing sacral, perineal or ischial wounds

Abstract Background The treatment of non-healing sacral, perineal, or ischial wounds often requires fecal diversion to promote wound healing. The purpose of this study was to identify risk factors for morbidity, rates of colostomy reversal and complications related to type of colostomy. A retrospective chart review was conducted on all patients with non-healing wounds who underwent diverting colostomies. Results Sixty six patients met criteria for inclusion in the study. Complication rates and revision rates were studied. 27% of all stomas required revision. Stoma revision was required in a higher proportion (33%) of all loop colostomies as compared to all end colostomies (10%). During the study period, 26% of diverted patients went on to have a myocutaneous flap. The stoma reversal rate was 5% (3/66). Complications occurred in 32% of patients. The most common complication was parastomal hernia (20%). Other complications included: small bowel obstruction, 8%; stoma prolapse, 6%; stoma bleeding 5%; and stoma retraction, 5%. Patients with loop colostomies had a higher rate of overall complications as compared to end colostomies (37% vs.10%) Conclusions Based on the findings of this study, consideration should be given to fashioning end sigmoid colostomies for fecal diversion in patients with non-healing wounds.

Types and Indications of Colostomy and Determinants of Outcomes of Patients After Surgery.

Colostomy is one of the commonest life saving procedures done worldwide with an intention of either decompression of an obstructed colon or diversion of stool. Indications may vary from region to region. Attending morbidity and mortality is significant. the objective of this study was to Determine the common indications and types of colostomy, and outcomes of patients operated at SPHMMC. A retrospective medical records of patients, operation log book and nursing records review was done in a two-year period between January 2011 and December 2013 at the College Teaching Hospital, St Paul's Hospital Millennium Medical, Addis Ababa. During the two years, 253 colostomies were done and 219(86.6%) cases used for analysis. Of these, 151(68.9%) were males. Age ranged from 15 to 85 years with a mean of 50.8. Most of the surgeries, 196(89.5%), were done for emergency conditions. The three most common indications were gangrenous sigmoid volvulus, 102(46.6%), colorectal cancers, 46(21.0%, and abdominal injuries, 28(12.8%). The commonest type of colostomy done was Hartman's colostomy, 179(81.7.1%), gangrenous sigmoid volvulus being the predominant indication, 102(57%). Loop colostomy constituted 35(16%) of all the colostomies. Penetrating abdominal injuries was the main indication 15(42.9%). Overall, 157 complications were seen on 106(48.4%) patients. The most common complications were surgical site infection, 51(23.3%), hospital acquired pneumonia, (10.5%), and wound dehiscence, 17(7.8%). The mortality rate was 9.6% (21). Gangrenous sigmoid volvulus is the leading indication for colostomy. Mortality and morbidity rates are high. Aggressive resuscitation, early prompt operation and post op close follow-up should be emphasized.

A study of complications related with colostomy closure

Objective: To determine the complications associated with colostomy closure following a suggested protocol and then compare the incidence with recent reported literature and to suggest measures for reduction of morbidity and mortality associated with colostomy closure. Study design: This study is based on a review of all the patients undergoing colostomy closure from August 1995 to September 1997 in East Surgical Ward, Mayo Hospital, Lahore. Material and methods: This prospective clinical study was carried out in the East Surgical Ward, Mayo Hospital, Lahore. A total of 32 patients belong to either sex who underwent colostomy closure following emergency colostomy were included in this study. Patients under 12 years of age were not included as these were managed in Paediatric Surgery Department of Mayo Hospital, Lahore. Time interval between construction and closure of colostomy was three months and all the patients were fit for anaesthesia. Pre-operative barium enema was done prior to admission to check a ny distal pathology like stricture or leakage. In only two cases strictures were found, and these patients were excluded from study. All patients were admitted through the outpatient department three days before operation, and a special proforma was filled for each patient. A detailed history was taken to find the time and indication for colostomy. A short note was made about the state of other injuries and site of colostomy. A thorough examination was performed to find the state of colostomy, type of colostomy and fitness of the patient. Results: A total of 32 patients were included in this study. Of these 26(81.2%) were male and 6 (18.7%) patients were female. 21(65.6%) were with loop colostomy, 7(21.8%) end colostomy with mucus fistula and 4(12.5%) were with end colostomy with Hartmann`s pouch. Penetrating injury of the colons is the most common etiology for colostomy at the initial operation. 15(46.8%) were made in the transverse colon, 13(40.6%) were made in the left colon and 4(12.5%) were made in the right colon. Conclusion: It has been concluded in this study that the most common indication for colostomy construction in Pakistan is the penetrating injury of abdomen. Young males are more commonly suffered from firearm injuries of abdomen. Loopogram should be done before colostomy closure especially in non-traumatic cases.

Clinical Profile and Outcome in Distal Gastrointestinal Tract Obstruction in Neonates with Special Emphasis on Role of Colostomy and its Complications

Background: Unlike adults or older children, the intestinal obstruction in neonates in majority of the cases is due to congenital anomalies. The mode of presentation can be acute, with obvious features of obstruction or presentation can also be more subtle and chronic in cases of incomplete or recurring and resolving bouts of obstruction. Aims and objectives: To determine the various causes, clinical presentation, type of surgical intervention, various types of colostomies, outcome (morbidity and mortality) of neonatal distal intestinal obstruction. Material and methods: This prospective study was conducted in the Department of Paediatric surgery of our hospital over a period of 2 years (between July 2013 to June 2015) and included all the neonates (age limit of 0 days to 1 month) presenting as lower gastrointestinal tract obstruction. Detailed history, clinical examination, investigations followed by proper surgical intervention if needed was carried out. Results: Of the total of 170 patients, 117(68.82%) were males and 53 (31.18%) were females with major chunk of babies born in health care facilities, 93 (54.71%), however still a good number of babies were born at home as well, 77 (45.29%).58(34.1%) patients were low birth weight ( 2.5 kg. In relation to gestational age, 39 (22.94% ) babies were preterm, 115 (67.64) babies were full term and 16 (9.41%) babies were post term. The presenting features varied significantly with abdominal distension (77.06%), failure to pass meconium (77.64%), vomiting and fluid and electrolyte disturbances being present in most of the patients. A total of 22 patients died with a mortality of 14.10%. It was higher in low birth weight neonates and in babies with co-morbidities (severe congenital anomalies, hypothermia, and severe respiratory embarrassment) and post-operative complications (bleeding diathesis, sepsis). Conclusions: Neonatal intestinal obstruction is one of the most common paediatric surgical emergencies presenting to our centre and every effort must be made to identify this entity as early as possible so as to address it at the earliest to minimize the morbidity and mortality associated with it.

Investigation of skin care status and self-care ability of patients with colorectal cancer

Objective To explore the nursing condition of the skin surrounding colon fistula and patients′ self-nursing abilities after discharge, then provide guidance for clinical health education. Methods Adopting convenience sampling to select 90 patients in our hospital with colorectal cancer followed up postoperatively from January to September 2015, and collected general data of patients, rating scales of the skin surrounding colon fistula and the questionnaire survey of self-nursing abilities. Results 48.9% of patients suffered different degrees of skin problems. There was significant difference in terms of the age, degree of education, marital status and types of colostomy (P<0.05). 66.44% of patients′ overall self-nursing abilities at a high level, and 35.56% patients In the medium level. Significant difference exists between the occurrence of skin problems and patients′ self-nursing abilities (P<0.05). Conclusions Currently, the skin problems surrounding the colon fistula appear very frequently after the patients were discharged, and self-care abilities reduce the incidence significantly. Key words: Colorectal cancer; Skin surrounding fistula; DET score; Self-nursing abilities