Dec 19, 2008

Colostomy in Anorectal malformation

Colostomy means surgically created stoma through the abdominal wall for the passage of stool.

This is done in many congenital anomalies. To name some of them are anorectal malformation (ARM), Hirschsprung's disease, Necrotizing enterocolitis (NEC) etc. The colostomy in ARM is usually temporary i.e. until the definite anal passage is created in the perineum. Colostomy is done as a first stage in high and intermediate type of ARM.

The types of colostomy are loop colostomy and completely divided skin bridge colostomy according to the way it is created. It can be transverse or high sigmoid colostomy according to the sit. Transverse loop colostomy is simple and rapid to create so preferred in emergency situation. In addition, it leaves large part of the colon for reconstruction. However, majority of times, high sigmoid colostomy is all that needed. High sigmoid colostomy is easy to maintain for longer period and easier for giving a distal colonic wash which is required for definite management of ARM.

The complications of colostomy are skin excoriation, colostomy prolapse, colostomy stenosis, colostomy retraction and pericolostomy herniation.

The distal loop washes are given until the definite management of ARM. Just before the reconstruction, distal loopogram is done to delineate the anatomy, which is useful for the final surgical repair. Colostomy is closed in third stage after 4-6 weeks of final reconstruction.