Complications of Ostomy Creation in Neonates

A new study suggests that although creating a temporary ostomy in newborns with acute abdominal disease is preferable in certain situations, there is a considerable occurrence of complications and reoperations.

Researchers at University Medical Center Groningen (UMCG; The Netherlands) retrospectively analyzed all data regarding 155 neonates (under 30 days of age) who underwent a laparotomy for a suspected abdominal emergency between 2000 and 2010 to assess the rate and type of complications after both ostomy creation and closure. Disease etiology was defined and various features of the enterostomy were analyzed, including type, location, time to ostomy take down, and complications and mortality directly related to both creation and closure of the ostomy.

The results showed that the median gestational age of the neonates was 33 weeks, and median birth weight was 1,926 grams; median age at laparotomy was 8 days. Indications for surgery were necrotizing enterocolitis, spontaneous intestinal perforation, intestinal atresia or obstruction, and volvulus. An ostomy was created in 67 patients (43%), of which 38 were boys and 29 girls. In almost all cases (94%) a mucous fistula was also constructed.

The researchers found that in 23 patients (34%) ostomy-related complications occurred, with the most frequent being high output ostomy and necrosis of the enterostomy. Due to either one of the complications, 13% needed a reoperation. In all, 11 patients died before ostomy closure could occur. In 53 patients, the ostomy was closed after a median of 107 days; after closure, complications occurred in 13 cases (25%); 7 patients needed another reoperation because of anastomotic leakage, adhesions, or incisional hernia. There was no closure-related mortality. The study was published in the August 17, 2012, issue of the European Journal of Pediatric Surgery.

“An ostomy seems a safe alternative in neonates with an acute abdomen when immediate restoration of bowel continuity is deemed undesirable,” concluded lead author Anne Van Zoonen, BSc, and colleagues of the division of pediatric surgery. “Although creating a temporary ostomy in newborns is preferable in certain situations, there is a considerable occurrence of complications and reoperations.”

An ostomy refers to a surgically created artificial opening (stoma) in the body for the discharge of body wastes. One well-known form of an artificial stoma is a colostomy, which is a surgically created opening in the large intestine that allows the removal of feces out of the body, bypassing the rectum, to drain into a a removable pouching system (adhesive or mechanical) that collects and contains the output for later disposal.

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