Ostomy is a surgical procedure used to create an opening for urine and fecesto be released from the body. Colostomy refers to a surgical procedure wherea portion of the large intestine is brought through the abdominal wall to carry stool out of the body.
A colostomy is created to treat various disorders of the large intestine, including cancer, obstruction, inflammatory bowel disease, ruptured diverticulum, ischemia (compromised blood supply), or traumatic injury. Temporary colostomies are created to divert stool from injured or diseased portions of the large intestine, allowing rest and healing. Permanent colostomies are performedwhen the distal bowel (bowel at the farthest distance) must be removed or isblocked and inoperable. Although colorectal cancer is the most common indication for a permanent colostomy, only about 10-15% of patients with this diagnosis require a colostomy.
Surgery will result in one of three types of colostomies.
In end colostomy, the functioning end of the intestine (the section of bowelthat remains connected to the upper gastrointestinal tract) is brought out onto the surface of the abdomen, forming the stoma by cuffing the intestine back on itself and suturing (sewing) the end to the skin. A stoma is an artificial opening created to the surface of the body. The surface of the stoma is actually the lining of the intestine, usually appearing moist and pink. The distal portion of bowel (now connected only to the rectum) may be removed, or sutured closed and left in the abdomen. An end colostomy is usually a permanentostomy, resulting from trauma, cancer or another pathological condition.
Double-barrel colostomy. This colostomy involves the creation of two separatestomas on the abdominal wall. The proximal (nearest) stoma is the functionalend that is connected to the upper gastrointestinal tract and will drain stool. The distal stoma, connected to the rectum and also called a mucous fistula, drains small amounts of mucus material. This is most often a temporary colostomy performed to rest an area of bowel, and to be later closed.
A loop colostomy is created by bringing a loop of bowel through an incision in the abdominal wall. The loop is held in place outside the abdomen by a plastic rod slipped beneath it. An incision is made in the bowel to allow the passage of stool through the loop colostomy. The supporting rod is removed approximately 7-10 days after surgery, when healing has occurred that will preventthe loop of bowel from retracting into the abdomen. A loop colostomy is mostoften performed for creation of a temporary stoma to divert stool away froman area of intestine that has been blocked or ruptured.
A colostomy pouch will generally have been placed on the patient's abdomen, around the stoma during surgery. During the hospital stay, the patient and hisor her caregivers will be educated on how to care for the colostomy. Determination of appropriate pouching supplies and a schedule of how often to changethe pouch should be established. Regular checking and meticulous care of theskin surrounding the stoma is important to maintain an adequate surface on which to apply the pouch. Some patients with colostomies are able to routinelyirrigate the stoma, resulting in regulation of bowel function; rather than needing to wear a pouch, these patients may need only a dressing or cap over their stoma.
Potential complications of colostomy surgery include excessive bleeding, surgical wound infection, thrombophlebitis (inflammation and blood clot to veinsin the legs), pneumonia, and pulmonary embolism (blood clot or air bubble inthe lungs' blood supply).
Complete healing is expected without complications. The period of time required for recovery from the surgery may vary depending of the patient's overallhealth prior to surgery. The colostomy patient without other medical complications should be able to resume all daily activities once recovered from the surgery. The doctor should be made aware of any problems such as increased pain, swelling, or redness in the surgical area, headache, dizziness, or increased abdominal pain.
Stomal complications, such as the stoma moving below the surface of the abdomen or increasing in length above it, or a narrowing of the stomal opening, need to be monitored.