ABSTRACT
Alexis Littre (1658-1726), the Parisian anatomist, is credited with being the first to propose a planned colostomy, or artificial anus. This occurred in 1710 during an autopsy on a child with anal atresia, when he explained how, after making an incision in the abdomen, it would be possible ‘to bring the superior part of the bowel to the abdominal wound, which should never be closed and which would perform the function of the anus’. It was not until 1776 that this concept was applied, when a colostomy was performed by Pillore of Rouen on an adult with rectal carcinoma. In 1783, Dubois is said to have been the first to construct a colostomy in an infant, but the patient, who had anal atresia, died after 10 days. The first long-term survivor was an infant, also with imperforate anus, who had a colostomy made by Duret in 1793 and was still alive 45 years later. During the nineteenth century, the procedure was introduced at centers across Europe and various modifications were developed, including loop colostomy over a rod by Maydl (1888). Operation ‘à deux temps’ reported in 1885 by Davies-Colley of Guy’s Hospital, London, consisted of suturing the bowel to the skin followed by delayed opening once the wound edges had sealed; this was an important development in an era when infection was the major cause of morbidity. The Hartmann procedure, described in 1923 for use following rectal excision for carcinoma at a time when anastomosis of the colon to the rectum was still dangerous, is still widely used in pediatric surgery.
