A colostomy is an artificial opening of the colon onto the anterior abdominal wall. There are two types of colostomy: end (defunctioning), and loop (decompressing).

An end colostomy is a defunctioning colostomy. It is commonly sited in the sigmoid colon (in the left iliac fossa). It is usually permanent (for example, following abdominoperineal resection for cancer of the rectum).

A loop colostomy can be created from any segment of the colon (but usually the transverse or sigmoid colon). It is a decompressing colostomy to relieve obstruction. It is usually temporary (although in advanced cancer an emergency loop colostomy to relieve obstruction may remain as a definitive procedure). A loop of colon is brought to the surface and supported for 5 to 7 days on a bridge. The stoma tends to be large and irregular. Leakage can be a problem. A loop colostomy does not always totally prevent the passage of feces into the distal colon.

The site for the stoma must be carefully chosen and the method of care discussed and explained. A stoma therapist should always be involved. The type of ostomy pouch must be carefully selected to suit the patient. Provided they have the manual dexterity, patients are encouraged to manage their own colostomy as soon as possible. In the postoperative period the stoma tends to be swollen and the effluent thin. During this phase a drainable bag can be useful so it does not have to be changed frequently resulting in soreness.

Skin care – Inflammation of the peri-stomal skin affects 50% of patients at some time.

There are two causes:

  • Contact dermatitis (allergy)

  • Effluent dermatitis (ill-fitting appliance)

An allergic reaction to the appliance causes itching and redness with a distinct margin. Change the type or brand of appliance.

Effluent dermatitis is due to prolonged contact with intestinal contents. Desquamation and secondary infection can occur, which may require steroid and antifungal creams. Inflamed skin is protected with a layer of stomahesive paste. Irregularities in the skin contour can be filled with Karaya gum, if necessary.

Fecal consistency – Stomal diarrhea is managed by:

  • Bulking agents

  • Opioid anti-diarrheals (if severe)

  • Diet modification

Foods that constipate include potatoes, white bread, rice, noodles, cheese, bananas and peanut butter.

Stomal constipation is diagnosed by digital examination and can be managed by an oil or phosphate enema followed by regular oral laxatives and increased intake of fluid and dietary fiber.

«  A colostomy will not retain suppositories.

To control flatus and smell, modify diet. Reduce or banish onions, cabbage, cucumbers, beans, lentils, fizzy drinks and (sometimes) milk products. Fish, eggs and cheese also tend to produce smell. Oral chlorophyll tablets can reduce smell. Activated charcoal or unscented deodorizers can be added to the bag. Odor-proof disposable bags are available, or flatus can be allowed to escape through a charcoal filter fitted to the appliance.

Prolapse is seen most often with a temporary loop colostomy. The stoma suddenly increases in size and protrudes. It can be reduced manually as a temporary measure. It seldom recovers spontaneously and requires surgery (to close or re-fashion). If the protruding mucosa becomes purple or black the patient will die of intestinal ischemia and necrosis without prompt surgery.

Parastomal hernia causes a bulge near the stoma on straining. It can be left alone unless it causes difficulty fitting the appliance or intermittent intestinal obstruction. The stoma is best re-sited unless the patient’s prognosis is short.

Obstruction can be due to impacted feces, adhesions or malignant involvement.

Bleeding is quite common and usually trivial, due to mucosal irritation. It stops with local pressure from a gauze pad. It can (rarely) be due to a stomal secondary deposit, and local cryosurgery can be helpful.

Rehabilitation – The psychological implications of a stoma are immense. Anxiety, depression, awareness of altered body image and sexual problems are all common. Counseling by a stoma therapist is important before and after surgery to overcome the psychological problems.

The author and publisher have taken precautions to ensure that the information in this book is error-free. However, readers must be guided by their own personal and professional standards of good practice in evaluating and applying recommendations made herein. The contents of this book represent the views and experience of the author, and not necessarily those of the publisher.

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