Thirty years of the health care service for ostomy patients in Juiz de Fora and surroundings

ABSTRACT Objective: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. Method: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. Results: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). Conclusions: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.

The average age among men was 56.2 years, while among women it was 58.4 years. The general average age was 57.2 years and there was a predominance of patients over 50 years old, as shown in Figure 1.   The most frequent cause that led to the placement of 340 colostomies was malignancy, occurring in 235 cases (69.1%), of which rectal cancer was the most reported, followed by colon cancer. Cancer of gynecological origin and cancer of the anus/anal canal occurred in smaller percentages. Less frequent causes were observed, such as intestinal obstruction, rectum or colon perforation (due to foreign body or trauma), diverticulitis, imperforated anus, rectovaginal fistula, and inflammatory bowel disease, the occurrence rates of which can be seen in Figure 4. We also identified other causes that led to the colostomy creation: peritonitis (4 cases), megacolon (2), Fournier's syndrome (2), acute abdomen (2), Hirschsprung's disease, stenosis of perineal colostomy, laceration of the rectum, polyp of rectum, rectal polyposis, and proctitis.
As for the 117 ileostomies, the prevailing cause was also malignancy, with 77 cases (65.8%), rectal and colon cancer being the most frequent, while bladder cancer and gynecological cancer displayed lower percentages.
Most colostomies were terminally and permanently made, predominantly on the left, as found by other authors 5, 10,12,17,19,20,29 . Terminal colostomy is often indicated when a long-term stoma is predicted, as in advanced rectal cancer or peritonitis 13 . lleostomies, on the Among all colostomized, ileostomized, and urostomized patients evaluated in this study, there was a predominance of males, 6.86% more than females.
In the literature, there are authors who describe male predominance 6-11 , while others observe a preponderance of females [12][13][14][15] . Our study demonstrated that malignant neoplasm was the main cause of creation of the derivations, and dermatitis, the most frequent complication in the three types of stoma. According to the World Health Organization (WHO) 16  other hand, were mostly created in loop and temporarily, predominantly to the right, being consistent with the literature 13,19,20,29 .
Of 457 intestinal stomas, 252 had one or more complications (55.1%) and this is comparable with other works, who report complication rates ranging between 23.0% and 60.0% 13,17,26,30  Prolapse in an uncommon complication of stomas and may be associated with parastomal hernia 19 .
In the intestinal ostomies analyzed, prolapse reached a percentage of 2.3% in colostomies and 0.8% in ileostomies, while parastomal hernia was present in 7.3% of colostomies and in 2.5% of ileostomies. In other studies, there was also a higher occurrence of these complications in colonic derivations than in ileal ones 6, 13,14,17,18,26,30 . It is important to monitor ostomized patients for the appearance of bulging, parastomal hernias, and prolapses, which cause discomfort, pain, and even poor adaptation to the bag. as immunotherapy or chemotherapy, and in some cases a urostomy may be necessary 29 . Resection of the bladder can be partial or total, and more advanced tumors may require complete removal of this organ, termed radical cystectomy 25,33