Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria

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Okoro Philemon E*,Onyesoh Chinyeaka, “Prolapse of colostomy in children; characteristics, predisposing factors and preventive measures in four health facilities in Southern Nigeria”, ijmhs, vol. 9, no. 5, pp. 440–446, Jun. 2019.
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Abstract

Introduction
The protrusion of the bowel through the stoma in a colostomy is one of the
common complications of colostomy. Though it rarely gets secondarily
complicated, it causes significant morbidity by virtue of the increasing bowel mass
outside. The predisposing factors and progression in children are not well reported
in our region.
Aim
To evaluate the characteristics and occurrence of colostomy prolapse in children
and to identify any factors predisposing to this complication in our practice.
Patients and Methods
This is a five year prospective study of paediatric colostomy in the authors’ service
between March 2013 and April 2018. Patients were categorized into those that
developed prolapse (Pro group), and those that did not (Non Pro group). Other
variables investigated were gender, age at creation of colostomy, indication, type,
and duration of colostomy, presence of raised intra abdominal pressure. Statistics
was with SPSS 21.
Results
Twenty seven (28.4%) of 95 children who had colostomy during the study period
developed prolapsed. Prolapse occurred more in patients who had their colostomy
at a relatively older age. There was a positive association of prolapse and
Hirschsprungs disease but no association with the gender or duration of stoma.
Conclusion
Colostomy prolapse is a common complication seen in our practice. Cases of
neglected Hirschsprungs disease in children have increased risk of this
complication. Extra caution is therefore needed in forming colostomy in this group
of patients.

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References

[1] Cataldo P, Mackeigan J. Intestinal stomas: Principles, techniques and management. 2nd ed.; InformaHealthcare Publisher: 2004. [2] Ameh EA, Dogo PM, Nmadu TN. Emergency neonatal surgery in a developing country. Pediatr Surg Int, 2001; 17 (5-6):448-451. [3] Brunicardi F C, Andersen D K, Billiar TR, Dunn D L, Hunter J G, Pollock R E. Schwartz's principle of surgery. 9th ed.; The McGraw-Hill Companies: 2011. Medline. [4] Garofalo T. Colostomy: Types, indications, formation and reversal. In: Fazio VW, Church JM, Wu JS (eds.). Atlas of intestinal stomas, Switzerland; Springer Nature:2018, pp.127-145. [5] Patwardhan N, Kiely EM, Drake DP, Spitz L, Pierro A. Colostomy for anorectal anomalies: high incidence of complications. J Pediatr Surg. 2001;36(5):795-8. [6] Jayarajah U, Samarasekara AM, Samarasekera DN. A study of long-term complications associated with enteral ostomy and their contributory factors. BMC Res Notes. 2016;9(1):500. [7] Ben Ameur H, Affes N, Rejab H, Abid B, Boujelbene S, Mzali R, et al. Surgical complications of colostomies. Tunis Med. 2014 ;92(7):482-7. [8] Uba AF, Chirdan LB. Colostomy complications in children. Ann Afr Med. 2003; 2(1):9-12. [9] Ekpemo SC, Eleweke N, Chapp-Jumbo A. Childhood colostomy and its complications in Aba, Nigeria. Int JClin Exp Med Sci.2018; 4(3): 32-34. doi:10.11648/j.ijcems. 20180403.11. [10] Engida A, Ayelign T, Mahteme B, Aida T, Abreham B. Types and indications of colostomy and determinants of outcomes of patients after surgery. Ethiop J Health Sci. 2016; 26(2): 117–120. [11] Irtan S, Bellaïche M, Brasher C, El Ghoneimi A, Cézard JP, Bonnard A. Stomal prolapse in children with chronic intestinal pseudoobstruction: a frequent complication? J Pediatr Surg. 2010;45(11):2234-7. doi: 10.1016/j.jpedsurg.2010.06.022. [12] Mullassery D, Lacona R, Cross K, Blackburn S, Kiely E, Eaton S, et al. Loop colostomies are safe in anorectal malformations. J Pediatr Surg. 2018;53(11):2170-2173. doi:10.1016/j.jpedsurg.2018.05.022. Epub 2018 Jun 1. [13] Davidson J, Healy C, Blackburn SC, Curry J. Laparoscopic enteropexy for prolapsing stoma: A case series describing a novel technique. J Laparoendosc Adv Surg Tech A. 2018;28(9):1135-1138. doi: 10.1089/lap.2017.0730. Epub 2018 Apr 6. [14] Gundogdu G, Topuz U, Umutoglu T. Laparoscopic correction of right transverse colostomy prolapse. Asian J Endosc Surg. 2013;6(3):220-2. doi: 10.1111/ases.12035. [15] Ekenze SO, Agugua-Obianyo NEN, Amah CC. Colostomy for large bowel anomalies in children. A case controlled study. Int J Surg. 2007;5:273-277. [16] Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N. Morbidity andmortality of colostomy and its closure in children. J Pediatr Surg. 2004;39(4):596-9. [17] Oda O, Davies D, Colapinto K, Gerstle JT. Loop versus divided colostomy for the management of anorectal malformations. J Pediatr Surg. 2014 ;49(1):87-90. doi: 10.1016/j.jpedsurg.2013.09.032. Epub 2013 Oct 8. [18] van den Hondel D, Sloots C, Meeussen C, Wijnen R. To split or not to split: colostomy complications for anorectal malformations or hirschsprung disease: a single center experience and a systematic review of the literature. Eur J Pediatr Surg. 2014;24(1):61-9. doi: 10.1055/s-0033-1351663. Epub 2013Aug 5. [19] Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg. 2002;68(11):961-6.

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References

[1] Cataldo P, Mackeigan J. Intestinal stomas: Principles, techniques and management. 2nd ed.; InformaHealthcare Publisher: 2004.
[2] Ameh EA, Dogo PM, Nmadu TN. Emergency neonatal surgery in a developing country. Pediatr Surg Int, 2001; 17 (5-6):448-451. [3] Brunicardi F C, Andersen D K, Billiar TR, Dunn D L, Hunter J G, Pollock R E. Schwartz's principle of surgery. 9th ed.; The McGraw-Hill Companies: 2011. Medline.
[4] Garofalo T. Colostomy: Types, indications, formation and reversal. In: Fazio VW, Church JM, Wu JS (eds.). Atlas of intestinal stomas, Switzerland; Springer Nature:2018, pp.127-145.
[5] Patwardhan N, Kiely EM, Drake DP, Spitz L, Pierro A. Colostomy for anorectal anomalies: high incidence of complications. J Pediatr Surg. 2001;36(5):795-8.
[6] Jayarajah U, Samarasekara AM, Samarasekera DN. A study of long-term complications associated with enteral ostomy and their contributory factors. BMC Res Notes. 2016;9(1):500.
[7] Ben Ameur H, Affes N, Rejab H, Abid B, Boujelbene S, Mzali R, et al. Surgical complications of colostomies. Tunis Med. 2014 ;92(7):482-7.
[8] Uba AF, Chirdan LB. Colostomy complications in children. Ann Afr Med. 2003; 2(1):9-12.
[9] Ekpemo SC, Eleweke N, Chapp-Jumbo A. Childhood colostomy and its complications in Aba, Nigeria. Int JClin Exp Med Sci.2018; 4(3): 32-34. doi:10.11648/j.ijcems. 20180403.11.
[10] Engida A, Ayelign T, Mahteme B, Aida T, Abreham B. Types and indications of colostomy and determinants of outcomes of patients after surgery. Ethiop J Health Sci. 2016; 26(2): 117–120.
[11] Irtan S, Bellaïche M, Brasher C, El Ghoneimi A, Cézard JP, Bonnard A. Stomal prolapse in children with chronic intestinal pseudoobstruction: a frequent complication? J Pediatr Surg. 2010;45(11):2234-7. doi: 10.1016/j.jpedsurg.2010.06.022.
[12] Mullassery D, Lacona R, Cross K, Blackburn S, Kiely E, Eaton S, et al. Loop colostomies are safe in anorectal malformations. J Pediatr Surg. 2018;53(11):2170-2173. doi:10.1016/j.jpedsurg.2018.05.022. Epub 2018 Jun 1.
[13] Davidson J, Healy C, Blackburn SC, Curry J. Laparoscopic enteropexy for prolapsing stoma: A case series describing a novel technique. J Laparoendosc Adv Surg Tech A. 2018;28(9):1135-1138. doi: 10.1089/lap.2017.0730. Epub 2018 Apr 6.
[14] Gundogdu G, Topuz U, Umutoglu T. Laparoscopic correction of right transverse colostomy prolapse. Asian J Endosc Surg. 2013;6(3):220-2. doi: 10.1111/ases.12035.
[15] Ekenze SO, Agugua-Obianyo NEN, Amah CC. Colostomy for large bowel anomalies in children. A case controlled study. Int J Surg. 2007;5:273-277.
[16] Chandramouli B, Srinivasan K, Jagdish S, Ananthakrishnan N. Morbidity andmortality of colostomy and its closure in children. J Pediatr Surg. 2004;39(4):596-9.
[17] Oda O, Davies D, Colapinto K, Gerstle JT. Loop versus divided colostomy for the management of anorectal malformations. J Pediatr Surg. 2014 ;49(1):87-90. doi: 10.1016/j.jpedsurg.2013.09.032. Epub 2013 Oct 8.
[18] van den Hondel D, Sloots C, Meeussen C, Wijnen R. To split or not to split:
colostomy complications for anorectal malformations or hirschsprung disease: a single center experience and a systematic review of the literature. Eur J Pediatr Surg. 2014;24(1):61-9. doi: 10.1055/s-0033-1351663. Epub 2013Aug 5.
[19] Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP. Stoma complications: a multivariate analysis. Am Surg. 2002;68(11):961-6.

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