colostomies

A colostomy is a surgical procedure in which a portion of the colon is diverted through an opening in the abdomen to create a stoma. This allows stool to exit the body into an external pouch rather than through the rectum. Colostomies may be temporary or permanent and are typically performed by colorectal surgeons during procedures to remove or bypass diseased sections of the bowel. The type of colostomy and its location influence stool consistency and the management required.

Indications include colorectal cancer requiring resection with a non-viable distal bowel, inflammatory bowel disease such as severe ulcerative colitis or Crohn's disease with obstruction, diverticular disease with perforation or fistula, trauma to the bowel, and certain congenital conditions. In some cases, a temporary loop colostomy is created to divert feces while the distal bowel heals.

Colostomies are named by the segment used: ascending, transverse, descending, or sigmoid. The proximal limb drains stool and the distal limb (in end colostomies) is closed or may be reversed later. Loop colostomies are often temporary. The stool consistency ranges from liquid to solid depending on location and adaptation.

During surgery, the bowel segment is brought through the abdominal wall to form a stoma. The distal segment may be left in place but nonfunctional. A skin barrier and ostomy pouch are worn over the stoma; care includes daily cleaning of the skin around the stoma and regular pouch emptying.

Care and prognosis: Most people adapt over weeks to months. Output varies by location: ascending colostomies tend to have looser stool, sigmoid colostomies more formed. Common complications include skin irritation, stoma retraction or prolapse, parastomal hernia, stenosis, and infection. Adequate hydration and nutrition support health, and ostomy nurses provide training and resources.

Reversal may be possible if the bowel heals after tumor removal or inflammation subsides, but not all colostomies are reversible. Postoperative quality of life improves with support groups and adaptive equipment.