A colostomy is a surgical procedure performed to attach one end of the large intestine to an opening in the abdominal wall (a stoma) through which body waste drains into a bag designed for the purpose. This operation is performed when a section of the colon has to be removed due to illness, infection or injury in order to give the remaining portion of the colon a chance to heal. The procedure may be performed as a temporary measure until healing takes place, or may be a permanent solution, especially when the rectum has also been removed.
Reasons for a Colostomy
A colostomy may be performed for a number of reasons, including damage to, or obstruction of, the colon as a result of:
- Inflammatory bowel disease
- Traumatic injury
- Gastrointestinal infection, such as perforated abscess
- Colorectal cancer
- Lower intestinal blockage
- Fistula in the perineum
If the condition that necessitates the colostomy heals completely, the colostomy can be reversed. The colon is surgically reconnected so that the patient is once again able to defecate normally.
The Colostomy Procedure
A colostomy is performed under general anesthesia in one of two ways: with as an open operation or a laparoscopic one. The traditional open surgery requires a large abdominal incision, whereas the laparoscopic one involves several small cuts in the abdomen. During the latter, the surgery is performed with the aid of a miniature camera, a computer screen and small surgical tools.
Although the location of the stoma varies according to which part of the colon is damaged, the opening is usually created on the left side of the abdomen. The tissue of the colon is stitched to attach to the outer skin to create a sturdy opening. A bag known as a stoma appliance is placed over the perimeter of the stoma to catch and contain the patient's feces.
In cases where the colostomy is performed as a temporary measure, once the patient's body has healed, there will be a second surgery to reattach the ends of the large intestine and close the stoma. This reparative surgery usually takes place about 12 weeks after the original procedure.
Risks of a Colostomy
While colostomies have become relatively common procedures and are generally considered safe, there are risks inherent in any surgical procedure. Risks of any surgical procedure may include:
- Internal bleeding
- Breathing difficulty
- Damage to adjacent organs
- Postsurgical infection
- Reopening of the wound
- Adverse reaction to anesthesia or medication
- Overgrowth of scar tissue
- Development of a hernia at the incision site
The risks of a colostomy procedure in particular include the chance that there will be a complication with the stoma, either in terms of a blockage developing, or in terms of a collapse of the stoma itself (stoma prolapse).
Recovery From a Colostomy
After a colostomy, the patient usually remains hospitalized for 3 days to a week, somewhat longer if the operation was performed as an emergency procedure. Immediately after a colostomy, patients may be given ice chips to suck on to ease thirst. Thereafter, their diet will progress from clear liquid to thicker liquids, soft foods and them harder foods. Many patients are able to resume eating normally within 2 days after surgery.
After a colostomy, patients must learn, from a trained ostomy nurse, how to empty and replace their colostomy bags. The process is not difficult, but requires scrupulous sanitary precautions.