Types and Indications of Colostomy and Determinants of Outcomes of Patients After Surgery

Abstract

BACKGROUND: Colostomy is one of the commonest life saving procedures done worldwide with anintention of either decompression of an obstructed colon or diversion of stool. Indications may vary fromregion to region. Attending morbidity and mortality is significant. the objective of this study was toDetermine the common indications and types of colostomy, and outcomes of patients operated atSPHMMCMETHODS: A retrospective medical records of patients, operation log book and nursing records reviewwas done in a two-year period between January 2011 and December 2013 at the College TeachingHospital, St Paul’s Hospital Millennium Medical, Addis Ababa.RESULTS: During the two years, 253 colostomies were done and 219(86.6%) cases used for analysis. Ofthese, 151(68.9%) were males. Age ranged from 15 to 85 years with a mean of 50.8. Most of thesurgeries, 196(89.5%), were done for emergency conditions. The three most common indications weregangrenous sigmoid volvulus, 102(46.6%), colorectal cancers, 46(21.0%, and abdominal injuries,28(12.8%). The commonest type of colostomy done was Hartman’s colostomy, 179(81.7.1%), gangrenoussigmoid volvulus being the predominant indication, 102(57%). Loop colostomy constituted 35(16%) of allthe colostomies. Penetrating abdominal injuries was the main indication 15(42.9%). Overall, 157complications were seen on 106(48.4%) patients. The most common complications were surgical siteinfection, 51(23.3%), hospital acquired pneumonia, (10.5%), and wound dehiscence, 17(7.8%). Themortality rate was 9.6% (21).CONCLUSION: Gangrenous sigmoid volvulus is the leading indication for colostomy. Mortality andmorbidity rates are high. Aggressive resuscitation, early prompt operation and post op close follow-upshould be emphasized.