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Article
A Study of 100 Cases of Stomas Performed in Child’s Central Teaching Hospital in Baghdad

Authors: Ahmed Zubar Zain --- Tharwat I.Sulaiman --- Sara Zuhair Fadhi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 3 Pages: 300-305
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Colostomy is an artificial opening made in the large bowel to divert faeces and flatus to exterior, where it can be collected in an external appliance. As a method of treating intestinal obstruction, colostomies date back to the later part of the eighteenth century, and some of the first survivors of this procedure were children with imperforate anus.OBJECTIVE:To identify the common indications and complications of stoma formation in pediatric age group below two years old.PATIENTS AND METHODS:A total number of (100) temporary colostomies and ileostomies (96 colostomies and 6 ileostomies) were preformed for (100) neonates, infants and children below two years of age in the pediatric surgical department of Child’s Central Teaching Hospital in Baghdad in the period from January 2005 to January 2007.RESULTS:Most of the colostomies and ileostomies (52%) were done in the neonatal period and mainly for imperforate anus (57.6%) and Hirschsprung’s disease (23.8%). Colostomy prolapse was the commonest complication and occurred in twenty patients 20% .the right transverse loop colostomy was the commonest stoma used in our patients and had the higher rate of complications. Prolapse ands skin excoriation were the most common complications in our study.CONCLUSION:Hirschsprung’s disease and imperforate anus were the most common indications of stoma formation in pediatric age group. Prolapse, skin excoriation and wound sepsis were the most common complications after creation of stoma.


Article
Burden of Mothers’ Care for Children with Colostomy at Baghdad Medical City Teaching Hospital
أعباء الأمهات للرعايه بالاطفال ذوي تفميم (فغر) القولون في مستشفى مدينه طب بغداد التعليمي

Author: Adraa H. Shauq عذراء شوق
Journal: nursing national Iraqi specility المجلة العراقية الوطنية للعلوم التمريضية ISSN: 18122388 Year: 2015 Volume: 28 Issue: 2 Pages: 8-23
Publisher: Baghdad University جامعة بغداد

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Abstract

Objective(s): To assess the burden of mothers` care for child with colostomy and find out relationships between child and mother socio-demographic data with mothers` burden.Methodology: a descriptive study was conducted from 1 August 2013 to 1 September 2014. The sample consisted of 100 children and their mothers at Baghdad Teaching hospital in Baghdad city. A questionnaire was prepared based on the previous literature review, meeting mothers of children with colostomy, and the Zarit Burden Interview scale. Data has collected through the application of questionnaire and interview techniques.Results: The data shows that mothers suffer from moderate burden socially, psychologically, financially, and overall burden of care. More than one third of mothers are within 38-40 years old, illiterate, with four children. Majority of them are unemployed and visit their children’s physicians regularly. More than half of families have somewhat sufficient monthly income and their child within 1-4 years old. Most of children are male and suffer from skin excoriation as complication. In addition, numbers of children in the family, physician’s follow-up, and mothers` age effects on mothers` social burden. Child’s age negatively correlates with financial burden. Ultimately, mothers’ age and their level of education, and family monthly income effect on mothers` psychological burden. Recommendations: mothers of child with colostomy experience a multitude of emotions and changes in their lives, often carrying caregiving burden. They become the experts on their child’s care and should be empowered and supported in their efforts. The level of mothers’ education should be increase and awareness about family planning.

المستخلص:الهدف: تقييم أعباء الأمهات للرعايه بالأطفال ذوي فغر القولون, وإيجاد علاقات بين المعلومات الديموغرافيه الاجتماعيه للطفل والام مع أعباء الأمهات.المنهجيه: دراسه وصفيه أجريت في الأول من شهر اب لعام 2013 ولغايه الأول من أيلول للعام 2014. تكونت العينه من 100 طفل مع امهاتهم في مستشفى بغداد التعليمي لمدينه بغداد. اعدت الاستبانه بالاعتماد على مراجعه الادبيات السابقه, الالتقاء مع أمهات أطفال ذوي تفميم القولون و مقياس المقابله ل Zairt للاعباء. جمعت العينه من خلال طريقه المقابله واستخدام الاستبانه.النتيجه: أظهرت النتائج ان الأمهات يشتكين من مستوى متوسط من الأعباء الاجتماعيه, النفسيه, الماليه, ومن كل الأعباء بصوره عامه. اكثر من ثلث العينه من الأمهات تتراوح أعمارهم 38-40 سنه, تقرا وتكتب ولديهن اربعه أطفال. اغلبهن لا يعملن (ربات بيوت) و يراجعن طبيب اطفالهن بانتظام. اكثر من نصف العائلات لديها دخل شهري يكفي لحد ما وتتراوح أعمارهم 1-4 سنوات. اغلب الأطفال ذكور ويعانون من انسلاخ الجلد كاحد المضاعفات لتفميم القولون. بالاضافه انه عدد الأطفال في العائله ومراجعه الطبيب واعمار الأمهات يؤثر على الأعباء الاجتماعيه للامهات. اما عمر الطفل فله علاقه عكسيه بالاعباء الماليه لهن. وأخيرا اعمار الأمهات و المستوى التعليمي لهن, و الدخل الشهري للعائله كان مؤثرا على الأعباء النفسيه للامهات. التوصيات: يواجهن أمهات الأطفال ذوي تفميم القولون مشاعر كثيره وتغيرات في حياتهن ويحملن عبء تقديم الرعايه غالبا. وقد اصبحن ذوي خبره في رعايه اطفالهن لذا يحتجن الى تشجيع ودعم لجهودهن. المستوى التعليمي للامهات والوعي حول استخدام وسائل تنظيم الاسره لابد ان يشجع.

Keywords

burden --- care --- colostomy --- burden --- care --- colostomy


Article
Necrotizing fasciitis: The role of early wide surgical

Author: Najeeb S. Jabbo
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 18-23
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Necrotizing fasciitis is a rare, progressive serious bacterialinfection of skin, subcutaneous tissue and fascia. It frequently affects theperineum and genital areas in which local redness and edema progressrapidly to necrosis and hemorrhagic bullae. Because of this rapidprogression, it is important to diagnose and treat necrotizing fasciitisquickly.Aims: To evaluate the role of early wide surgical debridement and diversioncolostomy in improving the prognosis.Methods: A case series study was done at Al‐ Yarmouk teaching hospital,involving all patients diagnosed with NF and treated by the authors for athree‐year period. Those patients were assessed clinically on admission andfollowed closely. All relevant demographic, clinical, biochemical andradiological data were documented. The methods of treatment with specialemphasis on surgical debridement were recorded. The clinical outcome,morbidity and mortality were recorded.Results: Seventeen cases were included, 11(64.7%) male and 6(35.3 %)female. The mean age was 51+‐7 years and 64.7% were diabetics. The primarysites affected were the perineum and scrotum, seen in 7 cases (41.1%). Themain presentation was excessive local pain, seen in 15cases (88.2%) and 15patients had initial constitutional symptoms (88.2%). Blood cultures andculture of debrided material revealed mainly group A streptococci andproteus. Early wide debridement was done in 9 cases (52.9%) and thosepatients had earlier healing and shorter stay in hospital (mean stay 20 days).Initial local debridement was done in 6cases (35.2%) and the mean durationof stay in hospital was 40 days. Diversion colostomy was done for 3 patients(29.4%) and all had early healing without mortality. There were 3 deaths(17.7%), two of them had initial local debridement.Conclusions: Early wide surgical debridement is essential and improveshealing, shortens hospital stay and decreases mortality. Diversioncolostomy is helpful in some cases but needs further evaluation.


Article
Factors That Predict The Morbidity of Colostomy in Patient with Ano-Rectal Malformation in Children in Baghdad

Author: Amer Abd Allah Ejrish
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2016 Volume: 13 Issue: 2 Pages: 294 -306
Publisher: Babylon University جامعة بابل

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Abstract

Colostomyis surgically fashioned colo-cutanous fistula for the diversion of the feces and flatus away from distal pathology or a surgical site either temporary or permanent type, indication of colostomies in our study were ARM.Identify the most common complication of colostomy in patient with ARM and how to be avoided, and which colostomy type carries a low risk of complication.Prospective study of 100 cases ARM that underwent colostomy was conducted at Medical City Children Welfare Teaching Hospital of department of pediatric surgery between January 2014 – November 2015.Most of colostomies (75%) were done in the neonatal period and mainly for recto urethral fistula in male (45%), the most common type of colostomy was a loop sigmoid colostomy (69%) this may be due to simplicity in creation and closure, in addition to surgeon's preference.Divided colostomy was done in 26 patients, and mainly for male patients. Seventy patients (70%) develop different complications and the most common were prolapsed (39%).others were skin excoriation, UTI, wound sepsis, parastomal hernia and bleeding.Prolapsed and skin excoriation were most in loop colostomies, while skin dehiscence was commonly seen in divided types. Associated anomalies were seen to be related to increase incidence of colostomy related complication. Mortality rate was (5%); the causes of death were septicemia, associated congenital anomaly and complex malformation.To decrease the incidence of prolapsed, it better to created divide rather than loop sigmoid colostomy for complete diversion of faces. We recommend divided proximal sigmoid colostomy for complete diversion of feces for protect definitive PSARP.


Article
Temporary Decompression after Colorectal Surgery Comparison of Loop Ileostomy and Loop Transverse Colostomy
مقارنة بين تفويه الامعاء الدقيقة وتفويه القولون المستعرض بعد جراحة القولون والمستقيم

Author: Ibtesam K.S. Al-Shadydy د.ابتسام خالد
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2008 Volume: 21 Issue: 4 Pages: 339-343
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Objective: The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following anterior resection with transected mesorectum for rectal cancer.Methods: Patients who required proximal diversion after anterior resection with transected mesorectal excision were randomized to have either a loop ileostomy or loop transverse colostomy. Post operative morbidity, stoma-related problems and morbidity following closure were compared.Results: From April 1995 to November 1999. 18-patients had a loop ileostomy and 12-had a loop transverse colostomy constructed following anterior resection for rectal cancer. Post operative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P=0.036). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma related complications after discharge from hospital. A total of five patients had intestinal obstruction from the time of stoma creation to stoma closure (four following ileostomy and one following colostomy).Conclusion: Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.Key words: Ileostomy, Transverse colostomy. Faecal diversion.

الخلفية والهدف : الهدف من الدراسة هو المقارنة بين تفوية الامعاء الدقيقة والقولون المستعرض كعلاج مفضل بعد عمليات الاستئصال الأمامي لأورام المستقيم.الطرق: المرضى الذين يحتاجون الى عمليات تحويل الخروج بعد الاستئصال الامامي لأورام المستقيم قُسموا الى مجموعتين الأولى بواسطة تفويه القولون المستعرض والثانية تفوية الامعاء الدقيقة. بعدها تم المقارنة بين المجموعتين بخصوص المضاعفات بعد العملية، المضاعفات التي لها علاقة بنوع التفويه قبل وبعد الغلق.النتائج: من نيسان 1995 الى تشرين الثاني 1999 ، (18) مريض أجريت لهم عملية تفويه الامعاء الدقيقة، (12) مريض تفويه القولون المستعرض بعد الاستئصال الامامي لأورام المستقيم. انسداد الامعاء مع كسل الامعاء تكون أكثر شيوعاً مع عمليات تفويه الامعاء الدقيقة. ليس هناك اختلاف في وقت الرجوع الى تناول الطعام، فترة الرقود في المستشفى بعد غلق التفويه، أو المضاعفات بعد غلق التفويه عند خروج المريض من المستشفى . خمسة حالات انسداد الامعاء من وقت التفويه لحين الغلق ، أربع منها حصلت بعد عمليات تفويه الامعاء الدقيقة وواحدة فقط به تفويه القولون.الاستنتاج: انسداد وكسل الامعاء تكون أكثر شيوعاً بعد حالات تفويه الامعاء الدقيقة من تفويه القولون المستعرض . وبذلك تعتبر عملية تفويه القولون المستعرض هي الطريقة المفضلة لتحويل مجرى الخروج بعد عمليات الاستئصال الامامي لأورام المستقيم.


Article
WHERE AND WHY DO WE SELECT THE TYPE AND SITE OF COLOSTOMY IN CHILDREN BELOW TWO YEARS

Authors: Salah S. Mahmood صلاح سلمان محمود --- Raghad J. Abolhab رغد جليل ابو الحب --- Mohamed J. Mohamed محمد جواد محمد
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2015 Volume: 13 Issue: 2 Pages: 137-142
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:Alexis Litter (1710) may be called the father of colostomy, when he made an incision in the belly and opened the ends of closed bowel to the belly surface where it never closed and preformed the function of anus for an infant suffered from intestinal obstruction due to congenital malformation of the return, probably an imperforate anus. This operation was known as Litter's operation.Objective:To decrease the incidence of colostomy complications through selection of proper site and type of colostomy.Methods:Two hundred temporary colostomies made for 200 neonates, infants and children below 2 years old in Al-Kadhemiya Pediatric Hospital and Al-Imamain Al-Kadhemain Medical City over a period from September 2008 to September 2013.Results:Imperforate anus was the most common indication for colostomy in 59% of cases and Hirschsprung's disease in 33.5%, which were done mainly in neonatal period (57%) especially for male imperforate anus without fistula. Prolapse was the most common and challenging complication following colostomy creation in 25% followed by severe skin excoriation 24% which mainly happened with loop transverse, while declining incidence in divided sigmoid and descending colostomies.Conclusions:Divided and separated descending and sigmoid colostomies were the stoma of choice for most clinical situations requiring colostomy because of complete fecal diversion with the least complications prolapse and skin excoriation.Keywords:Colostomy complications, prolapse, skin excoriation


Article
EARLY DIAGNOSIS AND PROMPT SURGICAL EXCISION WITH COMPLETE DIVERTING COLOSTOMY: IMPROVE THE OUTCOME IN PATIENTS WITH FOURNIER’S GANGRENE.

Authors: Jasim D Saud --- Noori H Jasim --- Majid A Mohammed
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 1 Pages: 82-86
Publisher: Basrah University جامعة البصرة

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Fournier’s gangrene is uncommon acute fulminating cellulitis of scrotum, perineum and groin which develops suddenly and often without any apparent causes. The aim of this study is to elucidate the effectiveness of early and extensive surgical excision with primarily performed complete diverting colostomy in outcome of patients. Fourteen patients with Fournier’s gangrene were included from January 2000 to October 2005 at Basrah General Hospital. History and examination has been taken. Treatment was in form of giving triple antibiotics. Early wide extensive excision of necrotic skin with complete diverting colostomy at the same occasion has been done in all patients. There were all male patients, their ages ranged between 4-75 years old, the average is 50 years. Determining the possible underlying cause finding that five patients has no obvious cause , three had perianal abscesses , determining the extent of disease , finding that in ten patients sloughing of tissue involved perineum , scrotum plus groin and or penis mortality were two out of fourteen patients ( 14%). Fournier’s gangrene is a rapidly progressive, fulminate infection. With institution of aggressive treatment, including early Surgical intervention, formation of completely diverting colostomy in first operation, haemo- dynamic support if needed, intensive care monitoring and broad spectrum antibiotic coverage, the disease has a greatly reduced mortality.


Article
5.SAFE PRIMARY REPAIR OF COLORECTAL INJURIES WITHOUT DIVERTING COLOSTOMY

Author: Taqi S. Atiyah
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2018 Volume: 16 Issue: 3 Pages: 258-267
Publisher: Al-Nahrain University جامعة النهرين

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Background: Colostomy was used for treatment of colorectal injuries since the 2nd World War, and it is a lifesaving procedure. There is a trend towards primary closure of colorectal injuries without colostomy in hemodynamically stable patients. Objective: To evaluate the safety of primary closure of colorectal injuries without colostomy in hemodynamically stable patients.Methods:A cross sectional study was performed at Al-Imamein Al-Kadhimein Medical City for patients with colorectal injuries over the period from July 2011 to July 2017. Management was started with active resuscitation of the patient, explorative laparotomy (securing hemorrhage) and assessment of the colorectal injuries. When the patients were stable hemodynamically without associated injuries to other parts of the body; debridement of the wound edges of the colon and primary repair by suturing in two layers using 2/0 absorbable suture (polyglactin) on a round needle with or without colostomy. But if the patients were in a shock state with multiple associated injuries to other parts of the body, with severely devascularized lacerated colon; proximal colostomy was done as a part of damage control surgery with resection of the devascularized segment and suturing of the distal end of the colon.Results: A total of 231 patients sustained colorectal injuries; 143 (61.90%) males and 88 (38.09%) females. The age of the patients ranged from 6-76 years, mean age was 32.16±76 year. Colostomy was done for 134 (58.01%) patients. Primary repair without colostomy were done for 97 (41.99%) patients. Postoperative follow up of the patients treated with primary repair of colorectal injuries without colostomy were detected collection and leaking repaired segment of colon in 5 (5.15%) patients. Re-exploration of the abdomen and colostomy were done for them. There was no mortality in patients treated without colostomy. The mortality rate was 9 (6.71%) for patients treated by colostomy due to associated multiple traumas to other parts of the body. Conclusion: Primary repair of colorectal injuries without colostomy are safe in a hemodynamically stable patient without associated injuries to other parts of the body.Keywords: Colorectal injury, primary repair, colostomy.Citation: Atiyah TS. Safe primary repair of colorectal injuries without diverting colostomy. Iraqi JMS. 2018; 16(3): 258-267. doi: 10.22578/IJMS.16.3.5


Article
Colostomy closure in post Conflict Iraq
غلق فغر القولون في عراق ما بعد الازمة

Authors: Mardukh S. Abd Ali د. مردوخ عبد علي --- Ali S. Al-Hashimi د. علي الهاشمي --- Najim A.I. Al-Khaldy د. نجم الخالدي
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2018 Volume: 60 Issue: 3 Pages: 137-140
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Colostomy minimizes the risk of leakage at expense of requiring a second operation. InIraq, published on colostomy closure in penetrating abdominal wall injuries is scarce.Objective: to Study the prognosis of colostomy closure in post-conflict patients in Iraq.Method: This is a retrospective study of 52 patients subjected to colostomy closure, recruited for theperiod 2008 to 2009 from Al-Yarmouk Teaching Hospital and Children Central Teaching Hospital.Demographic data and information about colostomy (type, methods of preparation … etc.) werestudied.Results: Trauma was noticed in 57.7% patients. Transverse colon was the commonest site of injuries.The complications were wound infection (19.2%), fecal fistula (3.8%), anastomotic leak (1.9%) andabdominal abscess (1.9%). A significant high complication rate was associated with conventionalmethod of preparation, and double layer anastomosis (p = 0.004 rand 0.003, respectively).Conclusion: the finding were comparable with other centers in the world.

الخلفية: فغر القولون يقلل من مخاطر التسرب على حساب الحاجة الى عملية اخرى. في العراق، الادبيات المنشورة عن عمليات غلق فغر القولونالناتج من الجروح النافذة لجدار البطن قليلة.الهدف: لتسجيل التخمين نتائج عملية غلق فغر القولون في عراق ما بعد النزاع.الطرق: تناولت الدراسة 52 مريضا خضع لعملية فغر القولون للفترة 2008 الى 2009 من مستشفى اليرموك التعليمي ومستشفى الطفل المركزيالتعليمي. تم استحصال معلومات ديموغرافية عن المرضى، وكذلك معلومات عن فغر القولون )النوع، وطرق تحضير المريض وغيرها(.النتائج: الجروح كانت السبب في تشكيل فغر القولون في 57.7 % من المرضى. القولون المستعرض كان الاكثر اصابة بالجروح. ومضاعفات.)% عملية غلق فغر القولون كانت خمج الجرح ) 19.2 %(، الناسور البرازي ) 3.8 %(، والتسرب التفاؤلي ) 1.9 %( وخراج البطن ) 1.9على التوالي(. ،p = 0.004 , المضاعفات من عملية غلق فغر القولون مرتبطة معنويا مع طريق التحضير التقليدي، واستخدام طبقتين ) 0.003استنتاج: نتائج عملية غلق فغر القولون تتوافق مع نتائج العمليات في المراكز العالمية.

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