Colostomy in children: Indications and common problems in Benin City, Nigeria

Objective: To evaluate the indications for colostomy and highlight associated problems as well as its contribution to the successful treatment of children. Methodology: This is a retrospective study of the indications, complications, parents/caregivers acceptance and outcome of colostomy in children over a ten-year period at the University of Benin Teaching Hospital, Benin City, Nigeria. Results: There were 46 children aged two days and 15 years (mean 3 months +/- 2.1) with mate/female ratio 2.8:1. Congenital anomaly was the major indication and accounted for 40 (87%) with associated higher morbidity and mortality and an observed significant statistical difference compared with the acquired indications (P<0.0001). Anorectal anomaly accounting for 22 (48%) and Hirschsprung's disease 18 (39%) were the congenital indications. Morbidity and mortality were mostly associated with children that had anorectal anomaly (P=0.0021). Acquired indications were mainly rectovaginal fistulae, perineal and left colonic injury which accounted for 6 (13%). Skin excoriation 39 (85%), colostomy prolapse 15 (33%) and persistent odour 21 (46%) resulted in poor acceptance by 10 (22%) parents/caregivers. Adequate preoperative counselling, skin protective paste and regular washing of colostomy site alleviated the complications. Wound infection and overwhelming sepsis were difficult to control in 14 (31%) with resultant six (13%) mortalities. Conclusion: Colostomy stilt has much to offer in emerging paediatric surgery units. Adequate preoperative counselling of parents/caregivers, good stoma care and early stoma closure gave good results in our setting.