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Colostomy

Definition

Colostomy is a surgical procedure that brings one end of the large intestine out through the abdominal wall. Stools moving through the intestine drain into a bag attached to the abdomen.

Alternative Names

Intestinal opening

Description

The procedure is usually done after bowel resections, bowel obstruction, or injuries. The colostomy may be temporary or permanent.

Colostomy is done while you are under general anesthesia (unconscious and pain-free). It may either be done with a large surgical cut in the abdomen, or with the use of a small camera and several small cuts (laparoscopy).

The type of approach used depends on what other procedure needs to be performed. In general, the surgical cut is made in the abdomen. The bowel resection or repair is performed as needed.

See also:

• Intestinal obstruction repair
• Large bowel resection

For the colostomy, one end of the healthy colon is brought out through the abdominal wall. The edges of bowel are stitched to the skin of the abdominal wall. A bag called a stoma appliance is secured around the opening to allow stool to drain.

Your colostomy may be short-term. If you have surgery on part of your large intestine, a colostomy will allow the other part of your intestine to rest while you recover. Once your body has fully recovered from the first surgery, you will have another surgery to reattach the ends of the large intestine. In general, this is done after 12 weeks.

Why the Procedure Is Performed

There are a number of reasons to perform a colostomy:

• Infection of the abdomen, such as perforated diverticulitis or an abscess
• Injury to the colon or rectum (for example, a gunshot wound)
• Partial or complete blockage of the large bowel (intestinal obstruction)
• Rectal or colon cancer
• Wounds or fistulas in the perineum -- the area between the anus and vulva (women) or the anus and scrotum (men)

Whether a colostomy is temporary or permanent depends on the specific disease or injury. In most instances, colostomies can be reversed.

Risks

Risks for any anesthesia include:

• Problems breathing
• Reactions to medications

Risks for any surgery include:

• Bleeding

Other risks include:

• Bleeding inside your belly
• Damage to nearby organs
• Development of a hernia at the site of the surgical cut
• Infection, especially in the lungs, urinary tract, or belly
• Narrowing or obstruction of the colostomy opening (stoma)
• Scar tissue forming in your belly and causing intestinal blockage
• Skin irritation
• Wound breaking open

After the Procedure

You will be in the hospital for 3 - 7 days. You may have to stay longer if your colostomy was done as an emergency operation.

You may be able to suck on ice chips on the same day as your surgery to ease your thirst. By the next day, you will probably be allowed to drink clear liquids. Your health care providers will slowly add thicker fluids and then soft foods as your bowels begin to work again. You may be eating normally within 2 days after your surgery.

The colostomy drains stool (feces) from the colon into the colostomy bag. Most colostomy stool is softer and more liquid than stool that is passed normally. The texture of stool depends on the location of the segment of intestine used to form the colostomy.

Outlook (Prognosis)

Before you are released from the hospital, a colostomy nurse will teach you about diet and how to care for the colostomy.

References

Fry RD, Mahmoud N, Maron DJ, et al. Colon and Rectum. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008: chap 50.

Cima RR, Pemberton JH. Ileostomy, Colostomy, and Pouches. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2006: chap 110.