Colostomy in the newborn: technical pitfalls.
Colostomy is a commonly performed procedure in the neonatal period but the procedure is frequently underestimated. This report is aimed at raising awareness to technical errors made in performing the procedure. In a period of 4 years, 5 patients who had colostomy in the neonatal period developed problems, which were attributed to errors made in performing the procedure and have been retrospectively reviewed. In 3 patients, the sigmoid colon was erroneously used for transverse colostomy resulting in poor function. There was increased blood loss and increase in operation time from colostomy take down at subsequent definitive surgery in all 3. In one other patient, the ileum was mistaken for the transverse colon and opened, requiring closure; the closure leaked necessitating laparotomy, resection and anastomosis but death occurred from peritonitis. The fifth patient developed stoma necrosis due to ligation of the marginal artery and narrow fascial opening. Colostomy refashioning was necessary but death occurred from overwhelming infection. The colostomies were performed at a peripheral hospital and by unsupervised residents. Colostomy in the newborn can be associated with significant morbidity and mortality and great care is necessary to avoid these. Some technical points to avoid these errors are highlighted.
Ameh
Emmanuel A
EA
Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. ameh@abu.edu.ng
D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006627:Hirschsprung Disease / Q000601:surgery; D006785:Hospitals, University; D006801:Humans; D007231:Infant, Newborn; D019300:Medical Errors / Q000009:adverse effects* / Q000706:statistics & numerical data; D009017:Morbidity; D009549:Nigeria / Q000453:epidemiology; D018579:Patient Selection; D012007:Rectum / Q000002:abnormalities / Q000601:surgery; D012307:Risk Factors; D013536:Suture Techniques