Colostomy

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List of terms related to Colostomy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Assistant Editor-in-Chief: Soumya Sachdeva

Overview

A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. This opening is formed from the end of the large intestine drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the stoma, and collect in a pouch attached to the patient's abdomen which is changed when necessary.

Types of colostomy

1. According to anatomic location
2. According to function
3. According to appearance
4. According to duration

According to anatomic location

• End sigmoid colostomy - Left iliac fossa
• End descending colon colostomy - Left iliac fossa
• Transverse colostomy - Above and right to umbilicus
• Caecostomy - Right iliac fossa

The appropriate stoma site must be selected pre-operatively for all the elective procedures and for most emergent operations.

According to function that the colostomy is intended for

• Diverting colostomy : Any colostomy may be regarded as 'Diverting' if it is so constructed that faeces are prevented from entering the diseased bowel distal to it. They are of 2 types : temporary and permanent
  • Temporary diverting colostomy : Usually loop colostomy - the purpose is to provide temporary diversion of faeces for :
    • Protection of the compllicated and threatened distal anastomosis e.g, following anterior resection of rectal cancer
    • Grossly infected diverticulitis with or without perforation
    • Traumatic injuries of the colon or rectum
    • Multiple,complicated and high perianal fistulae
  • Temporary diverting end colostomy : hartmann's procedure
  • Permanent diverting colostomy : An end colostomy - the purpose is to provide permanent diversion of faeces for :
    • Perforated unresectable rectal cancer
    • Late and unresectable rectal or anal cancer
    • Unrepairable lesion of rectum and anal canal following trauma, crohn's disease, hidradenitis suppurativa

• Decompression colostomy
  • The purpose is to provide decompression of hugely dilated large bowel proximal to obstructing growth of the rectum or sigmoid colon
  • Frequently done on emergency basis to prevent impending rupture of the dilated colon proximal to obstruction.
  • Useful and life-saving
  • Provides opportunity for a subsequent definitive cancer surgery without compromise of the principles of cancer surgery.
    • Types of decompression colostomy:
      • A loop transverse colube'ostomy
      • 'Blow hole' stoma constructed in the caecum or transverse colon.
      • Tube type colostomy

According to appearance of colostomy

• End colostomy
• Loop colostomy
• Double-barreled colostomy
• 'Blow hole' transverse colostomy
• 'Blow hole' caecostomy
• 'Tube' caecostomy

According to duration

• Temporary colostomy :
  • Indications-
    • To relieve a distal obstruction of the sigmoid colon due to any cause , commonly carcinoma or diverticulitis.
      • Usually performed as an emergency procedure to relieve obstruction as it is quick and easy to make.
      • The resection of the diseased part is carried out later on in a completely defunctioned segment of the colon which is empty, inactive and relatively sterile.
    • To defunction the distal colon and thus to protect a distal anastomosis after a low colorectal anastomosis.
    • To prevent faecal peritonitis after perforation of the colon following obstructive cancer, diverticulitis colon, traumatic injuries of colon or rectum
    • To facilitate the operative repair of high fistula in ano.
    • To prevent spoiling of the urinary bladder in vesico-colic fistula or vagina in vagino-colic fistula
  • It is of two types-
    • Loop colostomy : Commonly done with the transverse colon or sigmoid colon.
      • Method:
        • A temporary loop colostomy is made by bringing a loop of bowel to the surface of abdomen.
        • The loop is held in place by a glass or plastic rod or a rubber tube passed through a mesentry
        • So,loop colostomy is made by using the large bowel that has long mesentry e.g, transverse colon,sigmoid colon.
        • Most loop colostomies are made in the transverse colon in diseases involvng the left side of the colon.
        • Site of election:
          • Transverse colostomy is usually brought out above and to the right of umbilicus.
          • Sigmoid colostomy is usually brought out in the left iliac fossa.
        • Proximal half of the transverse colon to the right of the middle colic artery is preferred site, so that the entire left colon being left available for the subsequent formal operations in the future.
        • The colonic loop so brought out is sutured to the layers of the abdominal wall to prevent retraction and/or faecal soiling of the peritoneal swelling cavity.
        • The colostomy is opened along its exposed tenia coli to minimise bleeding from gut wall.
        • The opening may be made:
          • Immediately - when colostomy is done specially for distal obstruction i.e, for decompression
          • After 48 hours- when colostomy is made for other indications.
        • The glass or plastic rod is removed on the tenth postoperative day and replaced by a rubber tub
    • Double-barreled colostomy : Commonly done with sigmoid colon or transverse colon.

Indications

There are many reasons for this procedure: a section of the colon has had to be removed, e.g. due to colon cancer requiring a total mesorectal excision, diverticulitis, injury, etc, so that it is no longer possible for feces to pass out via the anus; or a portion of the colon (or ileum) has been operated upon and needs to be 'rested' until it is healed. In the latter case, the colostomy is often temporary and is usually reversed at a later date, leaving the patient with a small scar where the stoma was.

Options

Colostomies are viewed negatively due to the misconception that it is difficult to hide the pouch and the smell of feces, or to keep the pouch securely attached. However, modern colostomy pouches are well-designed, odor-proof, and allow stoma patients to continue normal activities. Latex-free tape is available for ensuring a secure attachment.

Colostomates (people with colostomies) who have ostomies of the sigmoid colon or descending colon may have the option of irrigation, which allows for the person to not wear a pouch, but rather just a gauze cap over the stoma. By irrigating, a catheter is placed inside the stoma, and flushed with water, which allows the feces to come out of the body into an irrigation sleeve. Most colostomates irrigate once a day or every other day, though this depends on the person, their food intake, and their health.

Placement of the stoma on the abdomen can occur at any location along the colon, the majority being on the lower left side near or in the sigmoid colon, other locations include; the ascending, transverse, and descending sections of the colon. Colostomy surgery that can be planned ahead often has a higher rate of long-term success and satisfaction than those done in emergency surgery.

Living with a colostomy

People with colostomies must wear an ostomy pouching system to collect intestinal waste. Ordinarily the pouch must be emptied or changed several times a day depending on the frequency of activity; in general the further from the anus the ostomy is located the greater the output and more frequent the need to empty or change the pouch.

Alternatives

In some rare situations it may be possible to opt for an internal colo-anal pouch which eliminates the need for an external pouch. In place of an external appliance, an internal ileo-anal pouch is constructed using a portion of the patient's lower intestine, to act as a new rectum to replace the removed original.

See also

• Ileostomy

Sources

• United Ostomy Associations of America

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