Experiences with childhood colostomy at a tertiary hospital in Mwanza, Tanzania

Abstract

Colostomy is a common life saving procedure in children and may be attended by significant morbidity. This cross-sectional study was carried out to describe experiences with childhood colostomy outlining the common indications, complications and their management and to identify factors associated with these complications in a tertiary hospital in Mwanza, Tanzania. Data was collected using a pre-tested, coded questionnaire. A total of 134 patients were studied. Seventy-eight (58.2%) were males and females were fifty-six (41.8%) (M: F =1.4:1). Their mean age was 1.83 years (range 1 day to 10 years). Anorectal malformations and Hirschsprung's disease were the most common indications for colostomy formation in 46.3% and 40.3%, respectively. Transverse loop colostomy was the commonest type of colostomy performed accounting for 79.1% of cases. Colostomy-related complications were recorded in 35.8% of cases. Skin excoriation and colostomy prolapse were the most common complications accounting for 19.4% and 17.9% respectively. The overall complication rate was significantly common in transverse colostomy than in sigmoid colostomy and in colostomies performed by junior doctors (P<0.001). The overall complication rate following colostomy closure was 23.4% and this was significantly associated with timing of closure and the rank of the operating surgeon (P < 0.001). The overall duration of hospitalization following colostomy closure ranged from seven to 24 days (mean = 8.60±2.62 days). The duration of hospitalization after closure was significantly longer in patients who had complications (P<0.001). Mortality rate was 8.3%. Colostomy formation and closure in our setting are commonly associated with high morbidity and mortality resulting from improper operative technique and inadequate follow up care. To minimize these problems, proper meticulous surgical technique and adequate follow up care may decrease the incidence of complications related to colostomy.