Abstract
Background An ostomy seems a safe alternative in neonates with an acute abdomen when immediate
restoration of bowel continuity is deemed undesirable. Faced with several complications
in our center, and the feeling we are not the only center with these complications,
we decided to assess the rate and type of complications after both ostomy creation
and closure.
Methods All data regarding neonates (<30 days of age) who underwent a laparotomy for a suspected
abdominal emergency in the period 2000 to 2010 were retrospectively analyzed. These
data included demographics such as gender, gestational age, and birth weight. Disease
etiology was defined and various features of the enterostomy were analyzed. These
features included type, location, time to ostomy take down, and complications and
mortality directly related to both creation and closure of the ostomy.
Results A total of 155 patients who underwent a laparotomy for suspect acute abdomen were
identified. Median gestational age was 33 weeks (range 25 to 40) and median birth
weight was 1926 g (range 560 to 4380). Median age at laparotomy was 8 days (range
0 to 30). Indications for surgery were necrotizing enterocolitis (n = 38), spontaneous intestinal perforation (n = 11), intestinal atresia (n = 9) or obstruction (n = 5), and volvulus (n = 4). An ostomy was created in 67 patients (67/155: 43%): 38 boys and 29 girls. There
were 8 jejuno-, 49 ileo-, and 10 colostomies created. In almost all cases (94%), a
mucous fistula was also constructed.
In 23 patients (23/67: 34%) ostomy-related complications occurred. Most frequent were
high output ostomy (n = 10) and necrosis of the enterostomy (n = 7). Due to either one of the complications, nine patients (9/67: 13%) needed a
reoperation.
In this study, 11 patients died before ostomy closure could occur. In 53 patients,
the ostomy was closed after a median of 107 days (range 4 to 299).
After ostomy closure, complications occurred in 13 cases (13/53: 25%). Seven patients
(7/53: 13%) needed another reoperation because of anastomotic leakage (n = 4), adhesions (n = 2), or incisional hernia (n = 1). There was no closure-related mortality.
Conclusion Although creating a temporary ostomy in newborns is preferable in certain situations,
there is a considerable occurrence of complications and reoperations.
Keywords
ostomy - neonate - acute abdomen
