what is colostomy surgery

Surgical Bowel Diversion: Colonic Exteriorization

Definition and Purpose

Exteriorization of the large intestine to the abdominal surface, creating an opening known as a stoma. This procedure diverts fecal matter from a portion of the colon, allowing it to heal or bypassing a diseased area. It can be temporary or permanent, depending on the underlying medical condition.

Indications

  • Obstructive conditions: Bowel obstruction due to tumors, strictures, or adhesions.
  • Perforation: Rupture of the colon caused by diverticulitis, trauma, or inflammatory bowel disease.
  • Inflammatory Bowel Disease (IBD): Severe cases of Crohn's disease or ulcerative colitis where medical management has failed.
  • Colorectal Cancer: Resection of cancerous tissue with anastomosis or diverting fecal stream to protect anastomosis.
  • Fecal Incontinence: In certain cases, to manage intractable fecal incontinence.
  • Trauma: Injuries to the colon requiring diversion for healing.

Procedure Types

  • Loop Exteriorization: A loop of the colon is brought to the abdominal surface, and an opening is created in the loop. This is often a temporary measure.
  • End Exteriorization: The colon is divided, and the proximal (upstream) end is brought to the abdominal surface, creating a single stoma. The distal (downstream) end may be closed off or brought out as a mucous fistula.
  • Double-barrel Exteriorization: Both the proximal and distal ends of the divided colon are brought to the abdominal surface, creating two separate stomas.

Stoma Characteristics

The stoma is typically located on the abdomen and appears as a pink or red, moist bud. It has no nerve endings, so it is not painful. The location and appearance vary depending on the type of diversion and the individual's anatomy. The effluent (fecal matter) consistency depends on the location of the exteriorization along the colon. The more proximal the stoma, the more liquid the effluent.

Postoperative Care and Management

  • Stoma Care: Cleaning and maintaining the stoma to prevent infection and skin irritation.
  • Appliance Application: Proper use of a pouching system to collect stool.
  • Dietary Considerations: Adjusting diet to manage stool consistency and gas production.
  • Complications: Potential complications include stoma retraction, prolapse, parastomal hernia, skin irritation, obstruction, and infection.
  • Psychological Support: Adjustment to life with a stoma, body image concerns, and social support.