| Colostomy | |
|---|---|
 Diagram showing a colostomy | |
| ICD-9-CM | 46.1 |
| MeSH | D003125 |
| MedlinePlus | 002942 |
Acolostomy is an opening (stoma) in thelarge intestine (colon), or thesurgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through anincision in the anteriorabdominal wall andsuturing it into place. This opening, often in conjunction with an attachedostomy system, provides an alternative channel forfeces to leave the body. Thus if the naturalanus is unavailable for that function (for example, in cases where it has been removed as part of treatment forcolorectal cancer orulcerative colitis), an artificial anus takes over. It may bereversible or irreversible, depending on the circumstances.
There are many reasons for this procedure. Some common reasons are:
Types of colostomy include:[1][2]
Colostomy surgery that is planned usually has a higher rate of long-term success than surgery performed in an emergency situation.[citation needed]
A colostomy may be temporary; andreversed at a later date; or permanent.
Colostomy orileostomy is now rarely performed for rectal cancer, with surgeons usually preferring primaryresection and internalanastomosis,[3] e.g. anileo-anal pouch. In place of an externalappliance, an internal ileo-anal pouch is constructed using a portion of the patient's lower intestine, to act as a newrectum to replace the removed original.
Placement of the stoma on theabdomen can occur at any location along the colon, but the most common placement is on the lower left side near thesigmoid where a majority of colon cancers occur. Other locations include theascending,transverse, anddescending sections of the colon.[4]
Pouches and the stick-on appliances to which they attach must be changed regularly. Sometimes an odor neutralizer and lubricant is squirted into a new pouch before it is attached. Two types of pouches are available: one disposable and one drainable. Most pouches are opaque and filter out air through a charcoal filter. The recommended practice is to empty such pouches when one-third full.[5] Appliances, in contrast with pouches, are usually replaced every three to seven days except in cases where their seals have broken contact with the skin, when they should be replaced immediately.[5]
Even as long ago as the 1940s, surgeons conducting areview at theCleveland Clinic (Jones and Kehm, 1946)[6] could summarize the routine care of the permanent colostomy as usually quite satisfactory, stating that after patients recover from the initial worry prompted by the need for a colostomy, most of them learn to manage their colostomy quite well.[6] "These patients come from all walks of life and carry on their daily work as usual. One patient stated that he could see no advantage of the normal anus over a colostomy. While this may be somewhat overstated, it is true that most people with a permanent colostomy can live a useful, happy life."[6] They found that, just as in anyone else, dietary indiscretion was the usual factor in occasional bowel habit disruption.[6] This historical experience has been borne out, as today the conclusion still stands that most patients can successfully manage a colostomy as part of theiractivities of daily living.
Jones and Kehm preferred tissue paper as a colostomy cover (held in place with a band or garment) rather than a colostomy bag.[6] They found that irrigation of the colostomy varied with each patient's bowel habit but that most patients developed a routine of every-other-day irrigation, whereas a few needed no irrigation.[6]
People with colostomies must wear anostomy pouching system to collect intestinal waste. Ordinarily, the pouch must be emptied or changed a couple of times a day depending on the frequency of activity; in general the further from theanus (i.e., the further 'up' the intestinal tract) the ostomy is located the greater the output and more frequent the need to empty or change the pouch.[7]
People with colostomies who have ostomies of thesigmoid colon ordescending 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, and to schedule irrigation for times that are convenient.[8] To irrigate, acatheter is placed inside the stoma, and flushed with water, which allows the feces to come out of the body into an irrigation sleeve.[9] Most colostomates irrigate once a day or every other day, though this depends on the person, their food intake, and their health.
Parastomal hernia (PH) is the most common late complication of stomata through theabdominal wall, occurring in 10-25% of patients,[10] even up to 50% by some estimates.[11]Prolapse of bowel wall through the stoma occasionally happens and can require reoperation to repair.[citation needed]
Following reversal of a colostomy, purse-string skin closure has been associated with a lower risk of surgical site infection than linear skin closure, and may lead to higher patient satisfaction, though current evidence suggests little or no difference in incisional hernia or operative time.[12]
Clinicalpilates-based exercises have been demonstrated to improve patients' core abdominal strength and to reduce the risk of a hernia worsening.[11]
Other common complications of colostomy are high output, skin irritation, prolapse, retraction, and ischemia.
