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Window Colostomy as a Preliminary Diversion Procedure in Cases of Congenital Short Colon-Lessons Learnt in 10 Years

Tanvir Roshan Khan* , Tanvir Roshan Khan* , Ashish Wakhlu*** , Kumar Abdul Rashid* , Madhukar Maletha** , J. D. Rawat*** , S. N. Kureel***

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New Indian Journal of Surgery 6(4):p 125-129, October-December 2015. | DOI: DOI : https://dx.doi.org/10.21088/nijs.0976.4747.6415.3

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Abstract

 Purpose: Congenital short colon (CSC) is an unusual abnormality in which a pouch like dilatation of a shortened colon is associated with ano-rectal malformation (ARM). The clinical features and anatomical features are very well described in the literature but the management remains difficult and controversial. The present paper aims to study the effectiveness of window colostomy (WC) as preliminary diversion procedure in the management of congenital short colon (CSC). Methods: All patients of CSC admitted to our department during a period of 10 years, in whom the WC was performed have formed the basis of this study. Out of total 137 patients admitted with CSC, window colostomy was done in 125 patients. These patients were retrospectively studied and the data sheets were analyzed regarding complications related to WC and the management offered. 5 patients expired before the procedure was undertaken, and transverse colostomy was done in 7 cases of incomplete CSC. Results: Eighty six patients were followed-up after WC and underwent all stages of management (WC followed by coloplasty and ileostomy and ileostomy closure in last stage).The procedure was associated with some distressing complications. Stenosis of the window colostomy needing dilatation was seen in 22 patients. 19 patients had minor prolapse of the pouch, while 6 of the patients had significant amount of prolapsed pouch needing revision procedures.18 patients had significant periostomy excoriation. The overall mortality related to the procedure was 11%. Conclusion: The formation of an initial window colostomy in the cases of CSC, may lead to incomplete fecal diversion, and the pouch fails to decompress properly. There are also complications associated with the stoma itself. However the procedure is short, easy to perform, and is life-saving and provides adequate time period to allow weight gain and be fit for second stage surgery. It eventually does not affect the final outcome in these patients with congenital short colon.

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DOI: DOI : https://dx.doi.org/10.21088/nijs.0976.4747.6415.3

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