Colostomy in children--an evaluation of acceptance among mothers and caregivers in a developing country.

BACKGROUND: Colostomy is a common procedure performed in children, mostly for anorectal malformation and Hirschsprung's disease. However, acceptance by parents in developing countries is thought to be poor. METHODS: A prospective evaluation was done to determine the acceptability of colostomy among parents and caregivers, and their attitude towards colostomy in their children. RESULTS: During the period January 1999 - January 2004 a structured questionnaire was administered to 57 parents and caregivers of children with colostomies (41 boys and 16 girls). The indication for colostomy was anorectal malformation in 28 children and Hirschsprung's disease in 29. The length of time the children had the colostomy ranged from 3 weeks to 8 years. Forty-four respondents (77%) found the colostomy and its management acceptable. Thirteen (23%) found the colostomy unacceptable, mainly because of a feeling of social isolation. Problems the respondents complained of included disturbing smell (17, 30%), frequent change of the cloth napkin used as colostomy appliance (15, 26%) and intermittent bleeding from the stoma (4, 7%). CONCLUSIONS: Colostomy in children is acceptable to most parents in our environment. Although some parents found it unacceptable, adequate explanation and counselling may modify their view.

Complications of scalp vein infusion in infants.

The scalp vein is an invaluable route for venous access in infants. Complications are rarely reported.

Symptomatic vitelline duct anomalies in children.

A wide variety of anomalies may occur as a result of the vitelline duct (VD) failing to obliterate completely. Most reports on symptomatic VD focus on Meckel's diverticulum, while other anomalies are given little attention. A retrospective review was conducted at our institution. According to the records 18 symptomatic children with VD anomalies were seen over 22 years, including 10 boys and 8 girls aged 11 days -14 years (median 7.5 months). Twelve patients aged below 10 years (median 28 days) had patent vitelline ducts (PVDs), 3 children aged 13 months, 13 years and 14 years respectively had Meckel's diverticulum (MD), presenting as inflammation, tapeworm incarceration and volvulus respectively. Two patients, both 8 years old, had umbilical sinus, and a 3-year-old had a vitelline cyst. Only 1 patient with PVD had an associated anomaly (intestinal malrotation). The diagnosis of PVD was obvious clinically, but in 1 patient the fistula was demonstrated by fistulogram. The diagnosis of MD was intraoperative in all 3 patients. Treatment was by various types of resection for PVD and MD and excision for umbilical sinuses and cysts. One patient with PVD developed postoperative intestinal obstruction from adhesions, requiring re-laparotomy and adhesiolysis. Two patients with PVD died from sepsis and anaesthetic-related complications, respectively. Although MD is the most commonly VD anomaly, PVD is the most common symptomatic presentation in our environment.