11

Vo l. 8 , No, 1. June 2002

Stomal Complications in Children

Joong-Jai Park, M.D., Joo-Hong Lee, M.D., Jong-Do Jung, M.D.,

Young-Cheol Choi, M.D., Woo-Shik Chung, M.D., Si-Youl Jun, M.D.

Department of Surgery, Masan Samsung Hospital, Sungkyunkwan University College of Medicine,

Masan, Korea

This is a 20 year analysis of the problems associated with enterostomy formation, and closure,

Forty-three stomas were established in 43 patients: 23 for anorectal malformations, 11 for Hirschsprung's diseases, 4 for necrotizing enterocolitis, 3 for multiple ileal atresias , 1 for

volvulus neonatorum with perforation, and 1 for diaphragmatic hernia with colon perforation, Thirty boys and 13 girls were included (mean age 4,8 months), Stoma complications were encountered in 13 patients (30,2 %): stomal prolapse , stenosis, obstruction, paracolic hernia,

retraction, dysfunction, and skin excoriation, Four patients (9,3 %) required stomal revision,

Occurrence of complications was not related to age and primary disease, but sigmoid colostomy

showed lower complication rate than transverse colostomy (20 ,0 % vs 42,9 %, p(0,05) , There were

five deaths but, only one (2,3 %) was directly related to the enterostomy complication,

Twenty-one stomas were closed in Qur hospital and complications occurred in seven patients

(33,3 %), The most common complication was wound sepsis in 5 children, In conclusion, because

the significant morbidity of stomal formation still exists, refinements of the surgical technique

seem to be required, Sigmoid loop colostomy is preferred whenever possible,

(J Kar Assoc Pediatr Surg 8(1):11 - 15), 2002.

Index Words: Colostomy, Complication, Child

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Correspondence: Si-Youl lull, MD., Department of Surgery,

Sungkyunkwan University College of Medicine, Masan Samsung

Hospital, 50 Hapsung-dong, Masan 630-522, Korea

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12

Table 1. Indication and Sex Distribution for Stoma Formation

Indications No. of patients(%) M/F

Anorectal malformation

Hirschsprung's disease

Necrotizing enterocolitis

Bowel atresia

Diaphragmatic hernia with perforation

Volvulus with perforation

Total

Table 2. Age Distribution at Stoma Formation

Age No. of patients (%)

1-28 d 31 72.1

1-11 m

over 1 yr

Total

11

43

25.6

2.3

100

23(53.5)

11 (25.6)

4(9.3)

3(7.0)

1(2.3)

1(2.3)

43(100)

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Table 3. Types of Stoma Formation

Type of colostomy No. of patients (%)

Transverse loop 21 48.8

Sigmoid loop 10 23.3

Ileostomy 6 13.9

Discending double 4 9.3

barrel

Discending end 2 4.7

Total 43 100

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Table 4. Complications after Stoma Formation

Stoma type Prolapse Stenosis Adhesive Parastomal

Retraction Skin

Dysfunction Total obstruction hernia excoriation

Transverse 7*

100p(n=21 )

Sigmoid 1* 0 0 100p(n=10)

Ileum 0 0 100p(n=6)

Discending double 0 barrel( n=4)

Discending 0 0

end(n=2)

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* p<0.05 (Transverse loop vs Sigmoid loop)

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Table 5. Complications after Colostomy Closure

2

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Colostomy type Wound sepsis Adhesive bowel Anastomotic Wound

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15

I. Goon HK: Repair of anorectal anomalies in the

neonatal period. Pediatr Surg Int 5: 246-249, 1990

2. Pena A: Management of anorectal malformations during

the newborn period. World J Surg 17(3): 385-392, 1993

3. AI-Salem AH, Grant C, Khawaja S: Colostomy com­

plications in infants and children. Int Surg 77(3):

164-166, 1983

4. ~Al ~, .I.~0J:, 01J8-§}, ~Al1%, 01%°.1: ?J1lWfl .5: Aj~ 'jj -l¥--&~E/ :W-714=-~.:f- ?J¥J"t-ofl -'f!H! !f!-4. rJl ~.2.]Jrj-~~ Al 33: 372-377, 1987

5. Nour S, Stringer MD, Beck J: Colostomy complications

in infants and children. Ann R Coll Surg Engl 78:

526-530, 1996

6. Mollitt DL, Malangoni MA, Ballantine TV, Grosfeld JL:

Colostomy complications in children. An analysis of 146

cases. Arch Surg lIS: 455-458, 1980

7. 3oli'-~ ~~(!6fJHI ~ *i): ~-t?-trJT S:Aa~: ~0}.2.]Jrj-~"fl

AJ, chap 6, ~A1A}, 1994, Pp65-72

8. O'Connor A, Sawin RS: High morbidity of enterostomy

and its closure in premature infants with enterocolitis.

Arch Surg 133(8): 875-880, 1998

9. Rokhsar S, Harrison EA, Shaul DB, Phillips JD:

Intestinal stoma complications in immunocompromised

children. J Pediatr Surg 34(12): 1257-1261, 1999

10. Patwardhan N, Kiely EM, Drake DP, Spitz L, Pierro A:

Colostomy for anorectal anomalies: High incidence of

complications. J Pediatr Surg 36(5): 795-798, 2001

II . Moore TC: Advantages of performing the sagittal an­

oplasty operation for imperforate anus at birth. J

Pediatr Surg 25(2): 276-277, 1990

12. Steinau G, Ruhl KM, Hornchen H, Schumpelick V:

Enterostomy complications in infancy and childhood.

Langenbecks Arch Surg 386(5): 346-349, 2001

13. Wright HK: Improving transverse colostomy function.

Am J Surg 132: 475-477, 1979

14. Golladay ES, Bernay F, Wagner CW: Prevention of

prolapse in pediatric enterostomas with purse string

technique. J pediatr Surg 25(9): 990-991, 1990

IS. Ein SH: Divided loop colostomy that does not prolapse.

Am J Surg 147: 250-252, 1984

16. Smith JAR, Taylor I: Complications of colostomy:

Complications of surgery of lower GI tract (ed 1), chap

9, Oxford, WB Saunders, 1985, Ppi06-128