Pattern of Lower Intestinal Ostomies in a Low-Income Country: Case of Southeast of Niger Republic.

Background
Intestinal ostomies are common surgical procedures performed in visceral surgery as part of management for several gastrointestinal diseases. This study aims to report the socio-demographic characteristics, indications and prognosis of intestinal ostomies in low-income country.

Methods
This was a 4-year retrospective study (January 2013 to December 2016) at Zinder National Hospital (Niger). All patients with a digestive ostomy on an ileum or colic segment were included in the study.

Results
During the study period, 2437 patients underwent digestive surgery, including 328 gastrointestinal stomas (13.5%). Patients classified ASA3 were 60.7% (n = 199). The median age was 12 years (IQ: 7–25). Children represent 64% (n = 210) of patients with ostomy. The sex ratio was 2.60. The stoma was performed in emergency in 96.3% (n = 316) of cases. Acute peritonitis was the main indication of the stoma in 70.73% (n = 232). The ileostomies accounted for 75.61% (n = 248). Ostomy was intended as temporary in 97.3% of cases (n = 319). Complications were observed in 188 patients (57.3%). Mortality was 14.02% (n = 46). The indigent status (OR: 4.15 [2.20–7.83], P = 000), ASA score 4 (OR: 2.53 [1.54–4.15], P = 0.0003), Altemeier class IV (OR: 4.03 [2.10–7.73], P = 0.0000) and ileostomy (OR: 2.7853 [1.47–5.29], P = 0.0018) were statistically associated with the occurrence of major complications. The mean time for stoma closure was 59.3 ± 14.5 days.

Conclusion
Acute peritonitis was the main indication of digestive ostomy. The occurrence of major complications was associated with bad socioeconomic status, ASA4 score, Altemeier class IV and ileostomy.