Pediatric Colostomy: Indications, Types, Care, Complications and Closure

Abstract

Colostomy as we know it today is the result of maturation in several areas of acceptance, technical modifications and clarification of indications. Although much of the history concerns all age groups, certain portions are related specifically to the infants.

Historical review

M. Littre/ a French surgeon, has been credited with the conception

, based on his brief suggestion in 1710 that an artificial abdominal anus can be used to relieve the obstruction of imperforate anus.2 The idea materialized sixty six years later, when M. Pillore performed a cecostomy on an adult with rectal carcinoma.1 The second colostomy was performed on an infant with imperforate anus in 1783. In 10 years the third colostomy on a moribund infant with imperforate anus was performed and produced the first long term survivor, the child was 3 days old and he lived for 45 years after the operation.

Amussae in 1839 introduced the extraperitoneal lumbar approach to the colon. It has the advantage of not opening the peritoneal cavity, but it has serious drawbacks: 1- It was a blind procedure and often the surgeon had little or no idea what the underlying pathology causing the obstruction was. 2- It was placed in the flank so was difficult to manage.

3- There was no established continuity of bowel epithelium to the skin so the stoma had a great tendency to stricture and stenosis.