Editing Colostomy

{{short description|Surgical procedure in which a hole is cut into the colon and stoma is placed}}
{{distinguish|Colonoscopy|Colotomy|Corpus callosotomy}}
{{Infobox interventions |
  Name        = Colostomy |
  Image       = File:Diagram showing a colostomy with a bag CRUK 061.svg|
  Caption     = Diagram showing a colostomy|
  ICD10       = |
  ICD9        = {{ICD9proc|46.1}} |
  MeshID      = D003125 |
  MedlinePlus = 002942 |
  OtherCodes  = |
}}

A '''colostomy''' is an opening ([[stoma (medicine)|stoma]]) in the [[large intestine]] (colon), or the [[surgical procedure]] that creates one. The opening is formed by drawing the healthy end of the colon through an [[Surgical incision|incision]] in the anterior [[abdominal wall]] and [[surgical suture|suturing]] it into place. This opening, often in conjunction with an attached [[ostomy pouching system|ostomy system]], provides an alternative channel for [[feces]] to leave the body. Thus if the natural [[anus]] is unavailable for that function (for example, in cases where it has been removed as part of treatment for [[colorectal cancer]] or [[ulcerative colitis]]), an artificial anus takes over. It may be [[Colostomy reversal|reversible]] or irreversible, depending on the circumstances.

== Uses ==
There are many reasons for this procedure.  Some common reasons are:
* A part of the colon has been removed, e.g. due to [[colon cancer]] requiring a [[total mesorectal excision]], [[diverticulitis]], injury, etc., so that it is no longer possible for feces to exit via the [[anus]].
* A part of the colon has been operated upon and needs to be 'rested' until it is healed. In this case, the colostomy is often temporary and is usually reversed at a later date, leaving the patient with a small [[scar]] in place of the stoma.  Children undergoing surgery for extensive [[pelvic tumor]]s commonly are given a colostomy in preparation for surgery to remove the tumor, followed by [[colostomy reversal|reversal]] of the colostomy.
* [[Fecal incontinence]] that is not responsive to other treatments.

== Types ==
[[File:Blausen 0247 Colostomy.png|thumb|Illustration depicting various types of colostomy]]
Types of colostomy include:<ref>Potter et al. ''Canadian Fundamentals of Nursing'' 3rd ed.2006, Elsevier Canada. p1393-1394</ref><ref>{{cite web |url=http://oncolex.org/Colorectal-cancer/Procedures/TREATMENT/Kirurgi/Stoma?lg=procedure |title=Stoma |access-date=2015-06-09 |url-status=dead |archive-url=https://web.archive.org/web/20151210221449/http://oncolex.org/Colorectal-cancer/Procedures/TREATMENT/Kirurgi/Stoma?lg=procedure |archive-date=2015-12-10 }}</ref>
* '''Loop colostomy:''' This type of colostomy is usually used in emergencies and is a temporary and large [[Stoma (medicine)|stoma]]. A loop of the bowel is pulled out onto the abdomen and held in place with an external device. The bowel is then sutured to the abdomen and two openings are created in the one stoma: one for stool and the other for mucus.
* '''End colostomy:''' A stoma is created from one end of the bowel. The other portion of the bowel is either removed or sewn shut ([[Hartmann's operation|Hartmann's procedure]]).
* '''Double barrel colostomy:''' The bowel is severed and both ends are brought out onto the abdomen. Only the proximal stoma is functioning. Most often, double-barrel colostomy is a temporary colostomy with two openings into the colon (distal and proximal). The elimination occurs through the proximal stoma.

Colostomy surgery that is planned usually has a higher rate of long-term success than surgery performed in an emergency situation.{{Citation needed|date=July 2007}}

=== Duration ===
A colostomy may be temporary; and [[colostomy reversal|reversed]] at a later date; or permanent.

=== Alternatives ===
Colostomy or [[ileostomy]] is now rarely performed for rectal cancer, with surgeons usually preferring primary [[Bowel resection|resection]] and internal [[anastomosis]],<ref name="ASCRS textbook">{{Cite book |title=The ASCRS textbook of colon and rectal surgery |publisher=Springer |year=2007 |isbn=978-0-387-24846-2 |editor-last=Wolff |editor-first=Bruce G. |location=New York |page=417 |editor-last2=American Society of Colon and Rectal Surgeons}}</ref> e.g. an [[ileo-anal pouch]]. In place of an external [[Prosthesis|appliance]], an internal ileo-anal pouch is constructed using a portion of the patient's lower intestine, to act as a new [[rectum]] to replace the removed original.

== Procedure ==
Placement of the stoma on the [[abdomen]] can occur at any location along the colon, but the most common placement is on the lower left side near the [[sigmoid colon|sigmoid]] where a majority of colon cancers occur. Other locations include the [[ascending colon|ascending]], [[transverse colon|transverse]], and [[descending colon|descending]] sections of the colon.<ref>Potter et al. ''Canadian Fundamentals of Nursing'' 3rd ed.2006, Elsevier Canada.p1393</ref>

==Routine care==
{{See also|Ostomy system}}
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.<ref name="Taylor">Taylor, C. R., Lillis, C., LeMone, P., Lynn, P. (2011) Fundamentals of nursing: The art and science of nursing care. Philadelphia: Lippincott Williams & Wilkins, page 1327.</ref> 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.<ref name="Taylor" />

Even as long ago as the 1940s, surgeons conducting a [[review article|review]] at the [[Cleveland Clinic]] (Jones and Kehm, 1946)<ref name="pmid_20274022">{{Citation |last1=Jones |first1=Thomas E. |last2=Kehm |first2=Ray W. |year=1946 |title=Management of the permanent colostomy |journal=Cleveland Clinic Quarterly |volume=13 |issue=4 |pages=198–203 |pmid=20274022 |doi=10.3949/ccjm.13.4.198 |s2cid=76078689 |url=https://www.mdedge.com/sites/default/files/issues/articles/media_6519270_ccq13_4-0198.pdf |postscript=. }}{{Dead link|date=December 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> 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.<ref name="pmid_20274022" /> "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."<ref name="pmid_20274022" /> They found that, just as in anyone else, dietary indiscretion was the usual factor in occasional bowel habit disruption.<ref name="pmid_20274022" /> This historical experience has been borne out, as today the conclusion still stands that most patients can successfully manage a colostomy as part of their [[activities 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.<ref name="pmid_20274022" /> 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.<ref name="pmid_20274022" />

People with colostomies must wear an [[ostomy 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 the [[anus]] (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.<ref name="UOAA">{{cite web|title=Colostomy irrigation: Colostomy Guide|url=http://www.ostomy.org/ostomy_info/pubs/ColostomyGuide.pdf|url-status=dead|archive-url=https://web.archive.org/web/20120623225004/http://www.ostomy.org/ostomy_info/pubs/ColostomyGuide.pdf|archive-date=23 June 2012|access-date=4 February 2013|publisher=United Ostomy Associations of America}}</ref>

=== Colostomy and irrigation ===
People with colostomies who have ostomies of the [[sigmoid colon]] or [[descending 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.<ref name="ostomy">{{cite web|last=Rooney|first=Debra|title=Colostomy irrigation: A personal account managing colostomy|url=http://www.ostomy.org/ostomy_info/pubs/Phoenix_Irrigation.pdf|access-date=7 September 2012|publisher=Ostomy}}</ref> To irrigate, a [[catheter]] is placed inside the stoma, and flushed with water, which allows the feces to come out of the body into an irrigation sleeve.<ref name="webmed">{{cite web|last=Wax|first=Arnold|title=What is colostomy irrigation?|url=http://www.webmd.com/colorectal-cancer/colostomy-irrigation|access-date=7 September 2012|publisher=WebMed}}</ref> Most colostomates irrigate once a day or every other day, though this depends on the person, their food intake, and their health.

==Complications==
[[File:Colostomy and parastomal hernia.JPG|thumb|Patient with a colostomy complicated by a large parastomal hernia, which is when tissue protrudes adjacent to the stoma tract.]]
[[File:Colostomy and parastomal hernia - CT.png|thumb|left|[[X-ray computed tomography|CT scan]] of same patient, showing intestines within the hernia.|alt=]]
Parastomal hernia (PH) is the most common late complication of stomata through the [[abdominal wall]], occurring in 10-25% of patients,<ref>{{cite journal|url=http://www.abdominalsurg.org/journal/2014/paraostomy-hernias-prosthetic-mesh-repair.html|title=Paraostomy Hernias: Prosthetic Mesh Repair|author=Paul H. Sugarbaker|journal=Abdominal Surgery|publisher=American Society of Abdominal Surgeons|date=2013|access-date=2015-10-28|archive-url=https://web.archive.org/web/20160131210854/http://www.abdominalsurg.org/journal/2014/paraostomy-hernias-prosthetic-mesh-repair.html|archive-date=2016-01-31|url-status=dead}}</ref> even up to 50% by some estimates.<ref name=":0">{{Cite journal |last=Taylor |first=Claire |last2=Munro |first2=Julie |last3=Goodman |first3=William |last4=Russell |first4=Sarah |last5=Oliphant |first5=Raymond |last6=Beeken |first6=Rebecca J |last7=Hubbard |first7=Gill |date=2023 |title=Hernia Active Living Trial (HALT): an exercise intervention in people with a parastomal hernia or bulge |url=http://www.magonlinelibrary.com/doi/10.12968/bjon.2023.32.22.S4 |journal=British Journal of Nursing |language=en |volume=32 |issue=22 |pages=S4–S11 |doi=10.12968/bjon.2023.32.22.S4 |issn=0966-0461 |archive-url=https://web.archive.org/web/20240311000000/http://www.magonlinelibrary.com/doi/10.12968/bjon.2023.32.22.S4 |archive-date=11 March 2024}} [https://eprints.whiterose.ac.uk/210090/ Alt URL]</ref>  [[Prolapse]] of bowel wall through the stoma occasionally happens and can require reoperation to repair.{{Citation needed|date=June 2024}}

Clinical [[pilates]]-based exercises have been demonstrated to improve patients' core abdominal strength and to reduce the risk of a hernia worsening.<ref name=":0" />

Other common complications of colostomy are high output, skin irritation, prolapse, retraction, and ischemia.
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==References==
{{Reflist}}

{{Stomas}}
{{Digestive system surgical procedures}}
{{Authority control}}

[[Category:Digestive system surgery]]