Colostomy

By: Jose Byron

Dadulla-Evardone

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 Definition

A colostomy is a surgical procedure

that brings a portion of the large
intestine through the abdominal
wall to carry feces out of the body.

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 Purpose

 A colostomy is created as a means to treat

various disorders of the large intestine,
including cancer, obstruction,
inflammatory bowel disease, ruptured
diverticulum, ischemia (compromised
blood supply), or traumatic injury.
Temporary colostomies are created to
divert stool from injured or diseased
portions of the large intestine, allowing
rest and healing.

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 Permanent colostomies are
performed when the distal bowel
(bowel at the farthest distance) must
be removed or is blocked and
inoperable. Although colorectal
cancer is the most common
indication for a permanent
colostomy, only about 10–15% of
patients with this diagnosis require a
colostomy.
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 Description

 Surgery will result in one of three

types of colostomies:

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 End colostomy
 Thefunctioning end of the intestine,
the section of bowel that remains
connected to the upper
gastrointestinal tract, is brought out
onto the surface of the abdomen to
form a stoma (an artificial opening)
by cuffing the intestine back on itself
and suturing the end to the skin.

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 The surface of the stoma is actually
the lining of the intestine, usually
appearing moist and pink. The distal
portion of bowel (now connected only
to the rectum) may be removed or
sutured closed and left in the
abdomen. An end colostomy is
usually a permanent colostomy,
resulting from trauma, cancer, or
another pathological condition.
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End Colostomy

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 Double-barrel colostomy
 This colostomy involves the creation of
two separate stomas on the abdominal
wall. The proximal (nearest) stoma is the
functional end that is connected to the
upper gastrointestinal tract, and will drain
stool. The distal stoma, connected to the
rectum, drains small amounts of mucus
material. This is most often a temporary
colostomy, performed to rest an area of
bowel and to be later closed.

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Double-barrel colostomy

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 Loop colostomy
 This colostomy is created by bringing
a loop of bowel through an incision in
the abdominal wall. The loop is held
in place outside the abdomen by a
plastic rod placed beneath it. An
incision is made in the bowel to allow
the passage of stool through the loop
colostomy.

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 The supporting rod is removed
approximately seven to 10 days after
surgery, after healing has occurred
that will prevent the loop of bowel
from retracting into the abdomen. A
loop colostomy is most often
performed for the creation of a
temporary stoma to divert stool
away from an area of intestine that
has been blocked or ruptured.
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Loop colostomy

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 Preparation

 The physician will outline the

procedure, possible side effects, and
what the patient may experience
after surgery. The physician or an
enterostomal therapist will explain
the general aftercare to the patient
before surgery, so the patient has all
of the information necessary to make
an informed decision about surgery
and medical care.
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 Blood and urine studies, along with
various x rays and an
electrocardiograph (EKG), may be
ordered as necessary. If possible, the
patient should visit an enterostomal
therapist, who makes the decision
about the appropriate place on the
abdomen for the stoma and who
offers pre-operative education on
colostomy management.

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 To empty and cleanse the bowel, the
patient may be placed on a low-
residue diet for several days prior to
surgery. A liquid diet may be ordered
for at least the day before surgery. A
series of enemas and/or oral
preparations (GoLytely or Colyte)
may be ordered to empty the bowel
of stool.

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 Oralanti-infectives (neomycin,
erythromycin, or kanamycin sulfate)
may be prescribed to decrease
bacteria in the intestine and help
prevent postoperative infection. On
the day of surgery or during surgery,
a nasogastric tube is inserted into
the nose to connect it to the
stomach to remove gastric
secretions and prevent nausea and
vomiting.

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A urinary catheter may also be
placed to keep the bladder empty
during surgery, giving more space in
the surgical area and decreasing the
risk of accidental injury.

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 Preparation

 Post-operative care for the patient with a

new colostomy involves monitoring of
blood pressure, pulse, respirations, and
temperature. The patient is instructed how
to support the operative site during deep
breathing and coughing, and given pain
medication as necessary. Fluid intake and
output is measured, and the operative site
is observed for color and amount of wound
drainage.

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 The nasogastric tube will remain in
place, attached to low-intermittent
suction until bowel activity resumes.
For the first 24 to 48 hours after
surgery, the colostomy will drain
bloody mucus. Fluids and electrolytes
are infused intravenously until the
patient's diet can gradually be
resumed, beginning with liquids.
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 Usuallywithin 72 hours, passage of
gas and stool through the stoma
begins. Initially the stool is liquid,
gradually thickening as the patient
begins to take solid foods. The
patient is usually out of bed in eight
to 24 hours after surgery and
discharged in two to four days.

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A colostomy pouch or bag will
generally have been placed on the
patient's abdomen, around the
stoma, during surgery. During the
hospital stay, the patient and the
caregivers will be educated on how
to care for the stoma and the
colostomy bag.

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 Determination of appropriate
pouching supplies and a schedule of
how often to change the pouch
should be established. Regular
assessment and meticulous care of
the skin surrounding the stoma is
important to maintain an adequate
surface on which to apply the pouch.

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 Patients will be instructed in daily
irrigation of the stoma about seven
to 10 days after surgery. This results
in the regulation of bowel function.
Some patients with colostomies may
need only a dressing or cap over the
stoma and do not wear a colostomy
pouch.

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 Often, an enterostomal therapist will
visit the patient at home after
discharge to help with the patient's
resumption of normal daily activities.

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 Complications

Potential complications of colostomy

surgery include:
 excessive bleeding

 surgical wound infection

 thrombophlebitis (inflammation and

blood clot in veins in the legs)

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 pneumonia

 pulmonary embolism (blood clot or

air bubble in the lungs' blood supply)
 cardiac stress due to allergic
reaction to the general anaesthetic

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 if the colostomy becomes blocked
 if the stoma extends too far out from
the abdomen, presenting the
potential for physical damage or
infection

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The physician should be made aware of any
of the following problems after surgery:

 increased pain, swelling, redness,

drainage, or bleeding in the surgical area
 flu-like symptoms such as headache,
muscle aches, dizziness, or fever
 increased abdominal pain or swelling,
constipation, nausea or vomiting, or black,
tarry stools

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Stomal complications to
be monitored include:

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 Necrosis (death) of stomal tissue.
 Caused by
inadequate blood
supply, this
complication is
usually visible 12
to 24 hours after
the operation and
may require
additional
surgery.
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 Retraction
 (stoma is flush with the
abdomen surface or has
moved below it). Caused
by insufficient stomal
length, this complication
may be managed by the
use of special pouching
supplies. Elective revision
of the stoma is also an
option.
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 Prolapse
 (stoma increases length above the
surface of the abdomen). Most often,
this results from an overly large
opening in the abdominal wall or
inadequate fixation of the bowel to
the abdominal wall. Surgical
correction is required when blood
supply is compromised.

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 Prolapse

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 Stenosis
 (narrowing at the
opening of the stoma).
Often, this is associated
with infection around the
stoma or scarring. Mild
stenosis can be removed
under local anesthesia,
while severe stenosis may
require surgery for
reshaping the stoma.

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 Parastomal hernia
 (bowel-causing bulge in the abdominal
wall next to the stoma). Usually, this is
due to placement of the stoma where the
abdominal wall is weak or the creation of
an overly large opening in the abdominal
wall. The use of a colostomy support belt
and special pouching supplies may be
adequate. If severe, the defect in the
abdominal wall should be repaired
surgically, and the stoma moved to
another location.

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Parastomal hernia

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Colostomy Care

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 Definition

A colostomy is a surgically created

opening in the abdominal wall
through which digested food passes.
It may be temporary or permanent.
The opening is called a stoma from
the Greek word meaning mouth.

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 Stoolpasses through the stoma into
a pouch attached to the stoma on
the outside of the abdomen. The
pouch, stoma, and skin surrounding
the stoma require care and
maintenance by the patient or
caregiver.

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 Purpose

A pouch is worn over a colostomy to

collect the stool passed through the
stoma. There are a variety of
pouches available for use with a
colostomy. Over time the patient can
determine which pouch type best
suits his or her needs.

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A colostomy pouch is normally
emptied one or more times daily.
The pouch itself usually needs to be
changed every four to six days. The
stoma and surrounding skin need to
be kept clean and sanitary.

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 Precautions

 Thenurse attending to a colostomy

should wash his or her hands before
and after the procedure, as well as
wear latex gloves while performing
care.

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 Description

A pouching system is normally worn

over a colostomy stoma. Pouches
can be obtained from several
different manufacturers in both
disposable and reusable varieties.
The enterostomal therapy ET nurse
can be an invaluable resource when
helping patients select a pouch
system.
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 Colostomy pouches may be either
open ended or closed. Open-ended
pouches require a clamp for closure.
They can be drained simply and
reused after they are emptied.
Closed pouches are sealed at the
bottom and are usually used by
patients who irrigate their
colostomies or who have a regular
bowel elimination pattern.
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 Two-piece pouch systems consist of a
separate flange and pouch. The pouch has
a closing ring that attaches to a matching
piece on the flange. One-piece systems
have a connected wafer and pouch that do
not separate. The portion of the pouch
that is applied to the abdomen is called a
skin barrier wafer. Both two-piece and
one-piece systems can be either closed or
open ended

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 Some patients with colostomies can
irrigate their stomas using a
procedure similar to an enema. This
cleans the stool out of the colon
through the stoma. A special
irrigation system is used. Sometimes
a special lubricant is used to prepare
for the irrigation. Irrigating often
leads to increased control over the
timing of bowel movements.
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 irrigation

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 Removing the colostomy appliance
requires gently pushing away the
skin surrounding the stoma and
pulling the appliance downwards.
Adhesive remover wipes are
available to help in the removal of
the wafer.

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 Thebag is then discarded in an
appropriate waste container. The
stoma should be cleaned with
lukewarm water and dried with a soft
towel.

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 The stoma and surrounding skin
should be assessed. The stoma
should be pink or red and moist-
looking, and may bleed slightly when
cleansed. The stoma normally
decreases in size slightly during the
first weeks after surgery.

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 The opening in the wafer should fit
snugly around the stoma. An opening
that is too large will allow intestinal
contents to leak onto the skin.
Measuring guides come with the
colostomy wafers so that the hole
can be cut to the proper size. Skin
barrier paste can be used to help
create a better seal between the
wafer and the patient's abdomen.
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 Variousskin preparation products are
also available to help protect the skin
under the wafer and around the
stoma. They also aid in the adhesion
of the wafer. Using the fingertips,
gentle pressure should be applied to
put the wafer in place.

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 Afterthe application of the barrier,
the bag should be applied (if it is a
two-piece system). If it is an open
system, apply a clamp to the bottom
of the new pouch.

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 Preparation

 The nurse should instruct the patient

and caregiver(s) about the procedure
before it is performed. Many people
feel anxious and nervous when first
dealing with an ostomy. Encourage
the patient to ask questions, and
explain all steps as they are
performed.

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 Aftercare

 The nurse should assess the patient's

tolerance of the procedure and
response to teaching or education
about the appliance.

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