The use of diverting colostomies in paediatric peri-anal burns: Experience in 45 patients

  • C E Price Department of Plastic and Reconstructive Surgery, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
  • S Cox Department of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
  • H Rode Department of Paediatric Surgery, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Keywords: Paediatric burns, Perineal burns, colostomy

Abstract

Background. Peri-anal burns are common in children. Continual exposure to enteric organisms may lead to a contaminated burn wound, invasive sepsis, graft loss, scar contracture, anal and urinary malfunction, and delayed discharge from hospital. Use of a temporary diverting colostomy has been advocated to reduce complications.

Objectives. To review the incidence, indications, methods, bacteriology, therapeutic effects and outcomes of colostomy for perianal burns.

Methods. A prospective study of children with peri-anal burns and stomas over a 17-year period. Prophylactic or therapeutic faecal diversion was achieved by temporary, divided sigmoid end-colostomy with Hartmann’s closure of the distal end.

Results. Between 1995 and 2012, 45 children with peri-anal burns received a colostomy. The mean total body surface area burned was 35% (range 3 - 80%). There were 28 flame burns, 16 fluid burns and 1 contact burn. Prophylactic colostomies were performed in 29 children, on average on day 6 after admission, and therapeutic colostomies to counteract deep wound infection and septicaemia in 16 patients, on average on day 24. In all but 2 cases there was a marked improvement in clinical appearance, graft take and healing. The bacterial profile changed from gut-derived organisms to Pseudomonas aeruginosa or no pathogens. Complications occurred in 5 patients (11.1%). Three stomas required manual reduction. Two children died of established septic shock, compounded by stomal dehiscence in 1 case. Reversal of the colostomy was performed on average at 4 months.

Conclusion. Diverting colostomy has therapeutic advantages in a select group of paediatric burns patients in whom continual faecal soiling poses a threat to both graft and life.

Author Biography

C E Price, Department of Plastic and Reconstructive Surgery, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Registrar Department of Plastic and Reconstructive Surgery.
Published
2013-07-31
How to Cite
Price, C., Cox, S., & Rode, H. (2013). The use of diverting colostomies in paediatric peri-anal burns: Experience in 45 patients. South African Journal of Surgery, 51(3), 102-105. https://doi.org/10.7196/sajs.1398
Section
Paediatric Surgery