Colostomies in Infancy and Childhood.

When considering the type and optimum time of treatment of such conditions as ano-rectal anomalies and Hirschsprung's disease in infancy, the choice usually lies between early definitive surgery, or a colostomy with postponement of the definitive surgery till the infant has reached a reasonable size. Often a decision in favour of colostomy is influenced by the widely held belief that this is a simple operation with minimal hazards and one that may be undertaken with relative impunity. Certainly Swenson (1957), in a follow-up of 200 patients treated for Hirschsprung's disease, found a mortality rate of 30%, and four out of the six deaths occurred in infants. This prompted the postponement of resection till the age of 12 to 18 months. To establish the mortality and morbidity rates of this operation and, if possible, to assess the most satisfactory technique, it was decided to carry out a survey on all colostomies done at this hospital from 1956 to 1961 inclusive. In this series there were 122 patients who had a total of 129 colostomies. The number per year is shown in Fig. 1. The fact that the numbers have increased in the latter years indicates a diminishing vogue for primary definitive surgery in ano-rectal anomalies. The age-groups at which the colostomies were performed are shown in Fig. 2. It can be seen that 41 cases, or nearly one-third, were performed in the first week of life and 54, or approximately 42% of the total number, were treated in the neonatal period, and of these almost all had ano-rectal anomalies or Hirschsprung's disease. The indications for the colostomies are shown in Table 1. This Table brings out the predominant position of ano-rectal anomalies and Hirschsprung's disease; 110 of the 129 colostomies were performed for one of these, either as a primary procedure or for a complication of a previous operation. Four of the cases included under the heading of Hirschsprung's disease presented in the neonatal period with intestinal obstructions, and at laparotomy seemed to