A study of complications related with colostomy closure

Abstract

Objective: To determine the complications associated with colostomy closure following a suggested protocol and then compare the incidence with recent reported literature and to suggest measures for reduction of morbidity and mortality associated with colostomy closure. Study design: This study is based on a review of all the patients undergoing colostomy closure from August 1995 to September 1997 in East Surgical Ward, Mayo Hospital, Lahore. Material and methods: This prospective clinical study was carried out in the East Surgical Ward, Mayo Hospital, Lahore. A total of 32 patients belong to either sex who underwent colostomy closure following emergency colostomy were included in this study. Patients under 12 years of age were not included as these were managed in Paediatric Surgery Department of Mayo Hospital, Lahore. Time interval between construction and closure of colostomy was three months and all the patients were fit for anaesthesia. Pre-operative barium enema was done prior to admission to check a ny distal pathology like stricture or leakage. In only two cases strictures were found, and these patients were excluded from study. All patients were admitted through the outpatient department three days before operation, and a special proforma was filled for each patient. A detailed history was taken to find the time and indication for colostomy. A short note was made about the state of other injuries and site of colostomy. A thorough examination was performed to find the state of colostomy, type of colostomy and fitness of the patient. Results: A total of 32 patients were included in this study. Of these 26(81.2%) were male and 6 (18.7%) patients were female. 21(65.6%) were with loop colostomy, 7(21.8%) end colostomy with mucus fistula and 4(12.5%) were with end colostomy with Hartmann`s pouch. Penetrating injury of the colons is the most common etiology for colostomy at the initial operation. 15(46.8%) were made in the transverse colon, 13(40.6%) were made in the left colon and 4(12.5%) were made in the right colon. Conclusion: It has been concluded in this study that the most common indication for colostomy construction in Pakistan is the penetrating injury of abdomen. Young males are more commonly suffered from firearm injuries of abdomen. Loopogram should be done before colostomy closure especially in non-traumatic cases.