Ivan R Diamond1, Paul W Wales. 1. Division of General Surgery, Group for Improvement of Intestinal Function and Treatment, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada.
Abstract
BACKGROUND: Infants with short bowel syndrome (SBS) frequently have proximal enterostomies with the colon excluded from intestinal continuity. Restoring intestinal continuity may create difficulty with perineal soiling. We propose creation of a distal sigmoid colostomy as an option for select infants with SBS. METHODS: This study involves the descriptive case series of all children with SBS who received a distal sigmoid colostomy. RESULTS: Eight infants (mean age, 70 days) received creation of a distal colostomy. In 1, placement of the colostomy was done at the initial surgery for SBS, 2 at the time of intestinal lengthening, and 5 during another procedure. Median length of small bowel was 58 cm. At 60 days postprocedure, median gain in enteral tolerance was 21% (P = .09), with median stoma output of 125% enteral intake. There were no complications directly attributable to the distal colostomy. CONCLUSION: Establishment of a distal sigmoid colostomy is an excellent management strategy for select children with SBS. It provides the benefits of restoring bowel continuity such as increased fluid and electrolyte absorption, improved energy absorption from fermentation of carbohydrate to short-chain fatty acids, and the theoretical enhancement of glucagonlike peptide 2 secretion that may optimize intestinal adaptation-all while protecting the perineal skin and simplifying quantification and collection of stool.
BACKGROUND:Infants with short bowel syndrome (SBS) frequently have proximal enterostomies with the colon excluded from intestinal continuity. Restoring intestinal continuity may create difficulty with perineal soiling. We propose creation of a distal sigmoid colostomy as an option for select infants with SBS. METHODS: This study involves the descriptive case series of all children with SBS who received a distal sigmoid colostomy. RESULTS: Eight infants (mean age, 70 days) received creation of a distal colostomy. In 1, placement of the colostomy was done at the initial surgery for SBS, 2 at the time of intestinal lengthening, and 5 during another procedure. Median length of small bowel was 58 cm. At 60 days postprocedure, median gain in enteral tolerance was 21% (P = .09), with median stoma output of 125% enteral intake. There were no complications directly attributable to the distal colostomy. CONCLUSION: Establishment of a distal sigmoid colostomy is an excellent management strategy for select children with SBS. It provides the benefits of restoring bowel continuity such as increased fluid and electrolyte absorption, improved energy absorption from fermentation of carbohydrate to short-chain fatty acids, and the theoretical enhancement of glucagonlike peptide 2 secretion that may optimize intestinal adaptation-all while protecting the perineal skin and simplifying quantification and collection of stool.