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Colostomy and ileostomy are surgically created openings in the abdominal wall that alter the normal route for elimination of feces (bowel diversion surgery). An opening (stoma) is created in the abdominal wall. The intestine (colon or ileum) is brought to the stoma to create an artificial outlet for the gastrointestinal tract (ostomy). This allows safe removal of waste material from food digestion when a portion of the intestine is removed or needs time to heal. The colon has four sections (the ascending colon, transverse colon, descending colon, and sigmoid colon) and along with the rectum forms the large intestine; diversion of the colon to the stoma is a colostomy. The ileum is the last portion of the small intestine; diversion of the ileum to the stoma is an ileostomy.
Because the stool is diverted from its normal course before reaching the anal sphincter, individuals with an ostomy are fecal incontinent. The stool, which is in a liquid state when it reaches the ileum and semi-solid when it reaches the colon, is diverted into an ostomy pouch (appliance) worn securely over the stomal opening. In some cases, after removing the colon (colectomy), a colon-like pouch can be created with a piece of healthy small intestine, avoiding the need for colostomy.
Intestinal stomas may be permanent or temporary. Often, a temporary stoma is created to allow a part of the bowel to heal after injury, disease, or surgical treatment (e.g., in diverticulitis, cancer, ulcerative colitis or Crohn's disease). After the area has healed, the stoma is closed, and the bowel is reconnected so that the normal elimination process can continue.
When the procedure is done as part of the treatment for colorectal cancer, the size and site of the tumor determine the type of surgical procedure (e.g., colectomy, partial colectomy, abdominoperineal resection). An attempt is always made to preserve the anal sphincter during the surgical approach if there is any chance that a permanent colostomy can be avoided. If there is severe involvement of the rectum, the anus and rectum are removed, and the anal area is closed (proctocolectomy, proctectomy).
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Source: Medical Disability Advisor
There are many reasons for the placement of an ostomy. A colostomy or ileostomy usually is created to bypass an obstructed portion of bowel or to divert the feces away from a segment of bowel that has been resected for some reason (e.g., cancer, disease, necrotic non-functional bowel).
The most frequent reason for the placement of a colostomy is removal of a segment of bowel that has been invaded by colon or colorectal cancer. Often the healthy bowel sections can be reconnected (anastomosis) during the cancer surgery if the entire bowel tumor has been removed. However, if this is not an option, a colostomy is placed to divert the feces until a later procedure can be performed to remove the ostomy. The colostomy may be permanent if significant resection of the colon, as well as resection of the rectum and anus, are necessary and normal elimination of feces cannot be resumed.
Other conditions treated with a colostomy or ileostomy include inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease), familial polyposis, Hirschberg disease, and ischemic or necrotic non-functioning bowel. Usually, individuals being surgically treated for ulcerative colitis, Crohn's disease, or familial polyposis do not need colostomy at the initial surgery, or the colostomy may be temporary. Ischemic bowel results in a section of necrotic non-functioning intestine that must be removed. The location and type of ostomy varies according to the extent of necrotic non-functioning bowel. Sometimes these ostomies are permanent.
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Source: Medical Disability Advisor
Surgery is performed in a hospital operating room under general anesthesia. The surgeon makes an incision in the abdomen and locates the affected portion of bowel. After performing other necessary procedures depending on the individual's disease, the surgeon will find a healthy segment of intestine to use for the ostomy. A small incision is made in a different location on the abdomen and a stoma is created. The portion of intestine (colon or ileum) for the ostomy is brought to that site and sutured to the abdominal wall. In some cases, (e.g., after abdominoperineal resection performed to treat colorectal cancer) the intestine will be pulled through the stoma and sutured on the skin surface (end-colostomy). Any ostomy that allows feces to be collected outside the body rather than eliminated through the anus is described as a "diverting ostomy." Sometimes a loop of intestine is brought up and connected to two stomas at the same location. This is a loop ostomy, which is often used to decompress an obstructed bowel.
After the individual recovers from anesthesia, it usually takes a few days for the ostomy to start eliminating feces. Once bowel function has returned, the individual can be started on a liquid diet, which is slowly advanced to a normal diet.
In cases in which only a temporary ostomy is required and healthy bowel remains, it is possible to reverse the ostomy procedure and re-establish normal bowel function. After cleansing the bowel at home, a laparoscopic procedure is performed to remove the stoma and restore bowel continuity without having to reopen the first abdominal incision. In some individuals, the need for more extensive surgery (e.g., to remove another portion of diseased or non-functioning intestine) will require an open surgical approach.
After undergoing ostomy surgery, individuals need to learn to care for the stomal appliance. Enterostomal therapists are specially trained nurses who can teach colostomy and ileostomy patients or caretakers how to care properly for their ostomies and help with other social or psychological aspects of adjusting to life after bowel diversion surgery.
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Source: Medical Disability Advisor
Colostomy and ileostomy generally are well tolerated, and most individuals make a full recovery. Individuals with ulcerative colitis or premalignant familial adenomatous polyposis who are treated with a proctocolectomy and a permanent ileostomy usually return to good health (Cima). A period of adjustment to having an ostomy and learning to manage the appliances is necessary. In most cases, individuals can continue to lead a full and active life. Further outcome considerations depend on the underlying disease process.
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Source: Medical Disability Advisor
Complications of colostomy and ileostomy are similar to those for other bowel surgeries, and include wound infection, bowel injury, ileus, bleeding (hemorrhage), and death. Sometimes the tissue that comprises the ostomy can die (necrosis) due to inadequate blood supply (ischemia). If this happens, a second surgical procedure will be required to create a new ostomy. Other complications of surgery include reactions to anesthesia and failure to heal due to other disease conditions or poor general health status.
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Source: Medical Disability Advisor
Individuals should avoid lifting, pushing, or pulling more than 5 to 10 pounds (2 to 5 kg) for at least 6 weeks immediately after the operation. The individual must learn how to use the appliances and care for the ostomy. Restrictions are similar after an ostomy reversal, but the duration is briefer, about 3 to 4 weeks.
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Source: Medical Disability Advisor
| CitedCima, Robert R., and John H. Pemberton. "Ileostomy, Colostomy, and Pouches." Sleisenger and Fordtran's Gastrointestinal and Liver Disease. Eds. Mark Feldman, Lawrence S. Friedman, and Lawrence J. Brandt. 8th ed. Philadelphia: Saunders Elsevier, 2006. MD Consult. Elsevier, Inc. 11 Sep. 2009 <http://mdconsult.com>.Fazio, Victor W., and Linda K. Aukett. "Bowel Diversion Surgeries: Ileostomy, Colostomy, Ileoanal Reservoir, and Continent Ileostomy." National Digestive Diseases Clearinghouse. Feb. 2009. 11 Sep. 2009 <http://digestive.niddk.nih.gov/ddiseases/pubs/ileostomy/index.htm>. |
Source: Medical Disability Advisor
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