The conditions that can require a colostomy include certain illnesses, injuries, or other problems with your digestive tract, including:
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Crohn’s Disease
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Diverticulitis
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An injury to the colon or rectum
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Intestinal obstruction, which is a blockage in the large bowel
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Colon Cancer
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Hirschsprung’s disease, a rare condition that mostly affects children, and can cause stools to become stuck in the bowels
A colostomy can be short-term (a few months), or a life-long situation. The different types of this procedure have to do with where they are located on the colon.
Temporary colostomy
A temporary colostomy gives part of the bowel time to heal by redirecting where stools go. This healing can take a few months or a few years, but once healing has occurred, the colostomy can be reversed.
Permanent colostomy
When part of the rectum becomes diseased — such as with cancer — a permanent colostomy is done. In this case, the diseased part of the colon is removed, or permanently cut off with the colostomy positioning.
Based on which part of the colon the colostomy is performed, they can further be divided into: -
Transverse
Ascending
Descending
Sigmoid
Colostomy
A colostomy is created from the colon (large intestine). It allows waste to exit the body through an opening in the abdominal wall. This type of ostomy can be temporary or permanent, depending on the underlying condition.
Transverse Colostomy
Transverse colostomies are some of the more common colostomies, and are divided into two types:
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Loop transverse colostomies
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Double-barrel transverse colostomies
Output
The output is fluid to pasty or semi-formed faeces and gas is common. The individual also experiences a decreased ability to absorb fluid and electrolytes as well.
The two types of transverse colostomy are as follows : -
In general, transverse colostomies are done in the upper abdomen. This type of colostomy allows the stool to leave the body before it reaches the descending colon. It is typically temporary and allows parts of the colon to heal.
With transverse colostomies, a lightweight, drainable pouch holds the stool and mucus and protects the skin from coming into contact with the stool. Usually, this pouch can easily be hidden under clothes.
Descending Colostomy
As the name would suggest, a descending colostomy is placed in the descending colon, on the lower left side of the abdomen.
Output
Faeces are usually semi-formed to solid and for most, nutrients from food and beverages are well-absorbed.
A double-barrel transverse colostomy is particularly suitable for specific medical conditions and scenarios where bowel diversion is necessary. Here are some key conditions and situations that make this type of colostomy more appropriate:
1. Colorectal Cancer
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Indication: Double-barrel colostomies are often performed in patients with colorectal cancer, especially when a significant portion of the bowel must be resected. This allows for the diversion of faecal matter while the affected area heals or undergoes treatment.
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Temporary Solution: It can serve as a temporary measure to allow for postoperative recovery and healing before any further surgical intervention or reversal.
2. Inflammatory Bowel Disease (IBD)
Indication: Conditions such as Crohn’s disease or ulcerative colitis may necessitate a double-barrel colostomy to manage severe inflammation or complications like strictures and fistulas. The separation of stool and mucus can help alleviate symptoms and protect the inflamed bowel segment.
Sigmoid Colostomy
A sigmoid colostomy is done on the sigmoid colon and is a few inches lower than a descending colostomy.
Output
The stool output is usually more solid and happens regularly, as a sigmoid colostomy allows for a larger part of the colon to still do its job, so
How
Colostomy
Surgery is Performed?
The patient is placed under general anesthesia to ensure they are unconscious and pain-free during the procedure.
Anaesthesia
1
A surgical incision is made in the abdomen, usually in the left lower quadrant for a colostomy. The size and location of the incision depend on the type of colostomy being performed (e.g., loop or end colostomy).
Incision
2
The surgeon identifies the section of the colon that will be brought to the surface to create the stoma. This may involve mobilizing the bowel and potentially removing any diseased or non-functioning segments.
Bowel Preparation
3
A segment of the colon is pulled through the abdominal wall to create a stoma, which is a small opening where stool will exit the body. The edges of the stoma are sutured to the skin to secure it in place.
Creating the Stoma
4
The incision in the abdomen is then closed using sutures or staples, and a pouching system is placed over the stoma to collect stool.
Closure
5
Ascending Colostomy
In an ascending colostomy, only a small portion of the colon stays active, and the colostomy itself is placed on the right side of the abdomen.
Output
Generally, watery faeces and gas is common. There’s a decreased ability to absorb fluid and electrolytes and dehydration can occur with excessive sweating, diarrhea, and/or vomiting. A drainable pouch has to be worn at all times.
Ascending colostomies are rare these days, and ileostomies are usually recommended instead.
Loop transverse colostomies
It creates two openings in the abdomen: One is for stools, and the other is only for mucus, a normal byproduct of defecation.
This type of colostomy allows for the diversion of faecal matter while enabling the distal portion of the colon to continue producing mucus. This setup is often temporary, allowing for healing or recovery from conditions affecting the bowel
Management:
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Pouching System: A lightweight, drainable pouch is used to collect stool and mucus. These pouches are designed to be discreet and can be easily hidden under clothing.
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Emptying the Pouch: The pouch should be emptied when it is about one-third full to prevent leaks. It can be detached from the skin barrier, emptied into a toilet, rinsed if necessary, and then reattached.
Double
barrel transverse colostomies
It involves dividing the bowel into two complete parts. Each part has its opening, or stoma, in the abdomen. Just like with a loop transverse, one opening is for stools, and the other is for only mucus.
This configuration allows for more effective management of stool and mucus separately. It is typically used when there is significant disease or damage requiring bowel diversion.
Management:
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Pouching System: Similar to a loop transverse colostomy, a drainable pouch collects waste from both stomas. The design accommodates two outputs while protecting the skin.
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Emptying the Pouch: Each stoma's output can be managed similarly; pouches should be emptied regularly based on fullness.
3. Diverticulitis
Indication: In cases of complicated diverticulitis, particularly with perforation or abscess formation, a double-barrel colostomy can be created to divert stool away from the affected area, allowing it to heal.
4. Bowel Obstruction
Indication: When there is an obstruction in the bowel, a double-barrel colostomy can help relieve pressure by allowing stool to bypass the obstructed segment, which is crucial for patient comfort and recovery.
5. Traumatic Injuries
Indication: Patients with penetrating bowel injuries may require a double-barrel colostomy to manage bowel integrity while allowing for healing of damaged sections.
6. Necrotizing Conditions
Indication: In cases where there is gangrene or necrosis of bowel segments, such as in Fournier's gangrene or severe ischemia, a double-barrel colostomy allows for immediate diversion and management of faecal matter while addressing the underlying issues.
7. Congenital Anomalies
Indication: In children with congenital conditions like Hirschsprung's disease, a double-barrel colostomy may be performed to manage bowel function until corrective surgery can be done.
Advantages in Specific Situations
Resting the Bowel
A double-barrel colostomy effectively rests the distal portion of the bowel, which may be inflamed or diseased, facilitating healing.
Mucus Management
The presence of a mucus fistula allows for better management of mucus output separately from stool, which can improve patient comfort and hygiene.
Flexibility for Future Surgery
It provides flexibility for future surgical interventions, including potential reversal when the underlying condition improves.