[size=20px]Regarding colostomy in the management of Hirschsprung’s disease, which of the following is true?

 

a- Colostomy may be indicated as a form of decompression in severe enterocolitis unresponsive to irrigations.

 

b- Diverting colostomy is best sited in the distal sigmoid colon.

 

c- Permanent colostomy is a form of treatment for total colonic aganglionosis.

 

d- Colostomy should be performed prior to treatments with colonic irrigations.

 

e- Colostomy, if performed, should always be a loop stoma.[/size]

A

a

correct answer

a- Colostomy may be indicated as a form of decompression in severe enterocolitis unresponsive to irrigations.

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The ideal treatment of Hirschsprung’s disease nowadays is a primary pull-through, without protective colostomy. A diverting colostomy may be indicated as an emergency procedure in very ill patients or if intraoperative pathology is not available. A diverting colostomy has to be sited at an optimal location which depends on the level of aganglionosis. Without the availability of pathological correlation, in most patients the safest area is proximal to the sigmoid colon – usually in the descending or transverse colon or an ileostomy. In a centre without a paediatric pathologist, diversion with a colostomy can be life-saving, with a reconstruction planned for a future date. If frozen section is available, an option is to perform a levelling colostomy. Then the colostomy can be pulled down at the time of the definitive repair. This deprives the patient of the protection of proximal diversion, but reduces the needed operations from three to two. A colostomy would be ineffective in the treatment of total colonic aganglionosis. An ileostomy is the preferred form of diversion.