Colostomy for anorectal anomalies: High incidence of complications

Purpose: The aim of this study was to characterize the type and incidence o f complications related to colostomy formation in newborn infants with anor ectal anomalies. Methods: The authors reviewed a 5-year (1994 to 1999) experience of a singl e institution in the management of neonates with high and intermediate anor ectal anomalies who required colostomy at birth. Patients with colostomy st ill in place have been excluded from the study to maximize the chances of d etecting 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 colo stomy formation was 2 days (range, 1 to 210). Mechanical complications rela ted 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, intussus-ception, and volvulus) in 7 (44%), and skin dehiscence in 3 (19%). One neonate had necrotizing enter ocolitis (NEC) after colostomy formation. Urinary tract infection was obser ved after colostomy in 14 infants (29%). The incidence of urinary tract inf ection was not higher in infants who had loop colostomy (11 of 39, 28%) com pared 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 t his series. Conclusions: Formation of colostomy for anorectal anomalies should not be c onsidered a minor procedure. In our experience the incidence of complicatio ns after colostomy formation is high. The incidence of urinary tract infect ions does not seem to be affected by the type of colostomy performed. J Ped iatr Surg 36:795-798. Copyright (C) 2001 by W.B. Saunders Company.