Colostomy for anorectal anomalies: high incidence of complications.
OBJECTIVE
The aim of this study was to characterize the type and incidence of complications related to colostomy formation in newborn infants with anorectal anomalies.


METHODS
The authors reviewed a 5-year (1994 to 1999) experience of a single institution in the management of neonates with high and intermediate anorectal anomalies who required colostomy at birth. Patients with colostomy still in place have been excluded from the study to maximize the chances of detecting colostomy-related complications.


RESULTS
There were 80 neonates with anorectal malformations, of whom, 49 (31 boys and 18 girls) were included in the study. The site of colostomy was sigmoid colon (n = 32), transverse colon (n = 7), and descending colon (n = 10). Thirty-nine colostomies were loop, and the remaining 7 were divided. The median birth weight was 2.96 kg (range, 1.46 to 3.88). The age at colostomy formation was 2 days (range, 1 to 210). Mechanical complications related to colostomy formation were observed in 16 infants (32%) with 3 infants having more than 1 mechanical complication. These included prolapse in 8 (50%), intestinal obstruction (adhesions, intussusception, and volvulus) in 7 (44%), and skin dehiscence in 3 (19%). One neonate had necrotizing enterocolitis (NEC) after colostomy formation. Urinary tract infection was observed after colostomy in 14 infants (29%). The incidence of urinary tract infection was not higher in infants who had loop colostomy (11 of 39, 28%) compared with infants who had divided colostomy (3 of 10, 30%). There were no differences in the incidence of colostomy-related complications and urinary tract infection between male and female infants. There were no deaths in this series.


CONCLUSIONS
Formation of colostomy for anorectal anomalies should not be considered a minor procedure. In our experience the incidence of complications after colostomy formation is high. The incidence of urinary tract infections does not seem to be affected by the type of colostomy performed.
Patwardhan
N
N
Department of Paediatric Surgery, The Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, London, England, UK.
Kiely
E M
EM
Drake
D P
DP
Spitz
L
L
Pierro
A
A
D000367:Age Factors; D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D001006:Anus, Imperforate / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D001696:Biomechanical Phenomena; D001724:Birth Weight; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007415:Intestinal Obstruction / Q000209:etiology; D008297:Male; D012003:Rectal Fistula / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D012005:Rectal Prolapse / Q000209:etiology; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D001747:Urinary Bladder Fistula / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D014548:Urinary Fistula / Q000145:classification / Q000175:diagnosis / Q000601:surgery*; D014552:Urinary Tract Infections / Q000209:etiology