Colostomy for large bowel anomalies in children: A case controlled study

Abstract

A significant number of colostomies for large bowel anomalies are constructed late in our setting. This is largely due to delayed presentation in Hirschsprung's disease and may be associated with increased morbidity. Loop colostomy is associated with higher rate of complication and as much as possible should be performed less often.

Outcome of Colostomies in Children: A Review of 48 Cases at Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria

“…The younger median age in our study is attributable to the younger age at presentation of children with anorectal malformations which constituted 68.7% of the indications. Consistent with findings from similar works in this domain, more males had colostomies than females in our survey with a ratio of 3.8: 1 [1,3,4,9]. This apparently is due to the higher incidence of ARM requiring colostomies and Hirschsprungs disease in males than females [10,11,12].…”

“…This is similar to findings by several other investigators in which anorectal malformation was a more common indication than Hirschsprung's disease [1,2,9,13,14]. This however contrasts with the reports of Ekenze, et al [4] in the same region in Nigeria, Uba, et al [3] and Nour, et al [15] who despite having both ARM and Hirschprung's disease as the most common indications put together however discovered that Hirschsprungs disease was a more common indication than anorectal malformation . We do not know the exact reasons for these regional variations however it may be a reflection of the variation in incidence of both conditions or as varied selection criteria for patients who would go for initial colostomy before the definitive pull through operation and those who would go for a single staged procedure for these anomalies.…”

“…There were 26 complications in 17 patients (35.4%) and this is within the range of previous reports [1,2,3,4,15] and the spectrum of complications is as in Table 3. Skin excoriation 12(46.2%) was the most common complication observed amongst the patients and this is consistent with previous reports [1,3,4,9,14].…”

“…Anorectal malformations and Hirschsprung's disease account for majority of the indications for colostomy in children [1][2][3][4][5]. Colostomies in children are largely temporary, so would be closed at a later date when the definitive treatment has been carried out [2,5].…”

“…Despite the life-saving benefits of colostomy in children, it is fraught with high rate of complications [1][2][3][4][5]. The burden of the associated morbidity and mortality together with the cost and inconvenience of a three stage procedure in anorectal malformations and high default rate has informed some investigators' recommendations that a single stage procedure be carried out in children with high and intermediate anomalies without an initial colostomy in some carefully select group of patients [6][7][8].…”