Colostomy type in anorectal malformations: 10-years experience.

AIM: The aim of this study was to evaluate the influence of colostomy type on morbidity during the treatment of anorectal malformations. METHODS: Sixty-eight infants (male: female ratio 1.3:1) with anorectal malformations that required colostomy were treated in our clinics during the period 1991-2001. Of these patients, 26 had received a loop colostomy: 14 of these underwent posterior sagittal anorectoplasty (PSARP) at the age of 9-12 months (Group A), and 12 underwent PSARP at the age of 2-4 months (Group B). Forty-two infants received a separated-stomas colostomy and underwent PSARP at the age of 9-12 months (Group C). The incidence of complications among groups was compared using the 2 sided Fisher's exact test. RESULTS: Eight cases from group A were complicated with prolapse of the stomas, perianal wound infection, pull-through dehiscence, and anal fibrotic stricture. The only complication observed in groups B and C was perianal wound infection, which occurred in 1 case from each group. A statistically significant difference was observed in the incidence of complication between groups A and C (p<0.001) and between groups A and B (p=0.014). The results from groups B and C did not differ significantly (p=0.398). When the cases complicated with colostomy prolapse were removed from the statistical analysis, groups A and C still differed significantly (p=0.001) but groups A and B did not (p=0.069). CONCLUSIONS: As the incidence of complications increases with time after a loop colostomy, we encourage either an early corrective procedure or the modification into separated-stomas colostomy (SSC) before PSARP is performed for those cases that would involve definitive surgery in late infancy.

Spontaneous pneumomediastinum: is a chest X-ray sufficient?

Spontaneous pneumomediastinum (SPM) is an uncommon disease defined as a non-traumatic presence of free air in the mediastinum, without underlying disease. We present a 13-year- old boy who was previously in a perfect health, who was presented with subcutaneous cervical emphysema, dysphagia, chest and neck pain. The chest roentgenogram revealed the presence of subcutaneous emphysema without any other abnormal findings. A computer tomography (CT) scan was obtained, and this confirmed the existence of subcutaneous cervical emphysema and also the presence of pneumomediastinum. The child's progress was uneventful and after 6 days he was discharged from the hospital in excellent clinical condition. We propose that chest CT is useful, in less obvious cases of SPM, to detect the free air in the mediastinum and probably SPM is underdiagnosed in clinical practice in the young people.