ENTEROSTOMAL COMPLICATIONS - ARE EMERGENTLY CREATED ENTEROSTOMAS AT GREATER RISK

It is not unusual for surgeons to have to construct a enterostoma duri ng an emergency abdominal operation. The enterostomal complications, o ften overlooked, can be serious for the patient. There are many factor s relating to stoma complications. The purpose of this paper is to det ermine whether the emergency status of an operation is an independent risk. Over a 19-year period from 1976 to 1995, there were 1758 enteros tomas constructed at our institution. Fifty-nine per cent were for eme rgent situations, defined as any operation performed for peritonitis, obstructions, or massive hemorrhage. The data pertaining to complicati ons was compiled by the enterostomal therapist and prospectively recor ded into an institutional database. Complications were characterized a s skin problems, parastomal problems (infection, separation), retracti on, stenosis, necrosis, prolapse, and herniation. There were 624 (35%) patients with recorded complications. It was not uncommon for a patie nt to have more than one complication. There were 500 (55%) skin probl ems, 111 (12%) parastomal problems, 104 (11%) retractions, 33 (4%) ste noses, 112 (12%) necroses, 28 (3%) prolapses, and 19 (3%) enterostomas herniated. Overall, there were 1044 emergently created enterostomas, and we found that 356 (34%) patients had a complication. The most comm on indications for emergency laparotomies were abdominal gunshot wound s (40%), bowel obstruction (20%), bowel perforation other than by guns hot or stab wound (15%), and diverticulitis (8%). Among the nonemergen tly created enterostomas (714), there were 268 (37%) with complication s (P = 0.15). Our findings suggest that emergently created enterostoma s are not at greater risk for complications, except for the ileostomy. Although further analysis of this particular subset must be undertake n, the technical intricacies of an ileostomy, including preoperative m arking of the site, might have an important role.