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

IntroductionThe protrusion of the bowel through the stoma in a colostomy is one of thecommon complications of colostomy. Though it rarely gets secondarilycomplicated, it causes significant morbidity by virtue of the increasing bowel massoutside. The predisposing factors and progression in children are not well reportedin our region.AimTo evaluate the characteristics and occurrence of colostomy prolapse in childrenand to identify any factors predisposing to this complication in our practice.Patients and MethodsThis is a five year prospective study of paediatric colostomy in the authors’ servicebetween March 2013 and April 2018. Patients were categorized into those thatdeveloped prolapse (Pro group), and those that did not (Non Pro group). Othervariables investigated were gender, age at creation of colostomy, indication, type,and duration of colostomy, presence of raised intra abdominal pressure. Statisticswas with SPSS 21.ResultsTwenty seven (28.4%) of 95 children who had colostomy during the study perioddeveloped prolapsed. Prolapse occurred more in patients who had their colostomyat a relatively older age. There was a positive association of prolapse andHirschsprungs disease but no association with the gender or duration of stoma.ConclusionColostomy prolapse is a common complication seen in our practice. Cases ofneglected Hirschsprungs disease in children have increased risk of thiscomplication. Extra caution is therefore needed in forming colostomy in this groupof patients.

Perineal colostomy prolapse: a novel application of mesh sacral pexy

Full thickness colonic prolapse following pseudocontinent perineal colostomy has not been previously reported. Possible contributing factors include a large skin aperture at the site of the perineal stoma, the absence of anal sphincters and mesorectal attachments and the presence of a perineal hernia. A novel application of sacral pexy combined with perineal hernia repair using two prosthetic meshes is described.

Muscle splitting sigmoid loop colostomy: a viable option to prevent colostomy prolapse

Background: The purpose the study was to assess the incidence of Colostomy prolapse with sigmoid loop colostomies performed through rectus muscle splitting Incision.Methods: Colostomy prolapse may present serious problems for patient care and stoma function6. Sigmoid loop colostomy was done for babies with High anorectal malformation (HARM) and Hirschsprung’s disease (HD) from Jan2012 to Dec2014 in two referral hospitals. All colostomies were sigmoid loop colostomies and done by a single surgeon through rectus muscle splitting incision. All patients were followed up for colostomy prolapse for at least 6 months.Results: A total of 110 babies managed with colostomy during the study period. The patients comprised of 68 males and 42 females. High anorectal malformation accounted for 66 babies [males 48, females18] while Hirschsprung’s disease was the surgical indication in 44 [males20, females24]. The age at colostomy ranged from 1day to 4 years. A total of 32 complications were recorded in 25patients [29%]. There were 4 deaths [3.6%]. Early complications like Haemorrhage and septicaemia was seen 4 patients. Colostomy stenosis was observed in 3 cases requiring only dilatation. Colostomy prolapse was seen only in 3 patients [3.24%]. Skin excoriation was the commonest complication, noted in 10 patients. Failure to thrive secondary to colostomy diarrhoea was observed in 3 patients. Superficial wound dehiscence occurred in 3 babies. Urinary tract infection seen in 5 and Intestinal obstruction requiring laparotomy occurred in one baby.Conclusions: Colostomy prolapse is very common after loop colostomies. Rectus muscle splitting incision for loop colostomies is safe and is associated with low incidence of colostomy prolapse.