Dr. Ertan Beyatlı

What is a colostomy and who is it for?

(Update: ) - Digestive System Diseases

A lot of people have heard of these two words, but I guess not many know the meaning and why they are made. Because colostomy and ileostomy procedures are generally known by patients with diseases associated with these conditions and their relatives. In this article, I will give useful and brief information about these situations.

What is a colostomy?

Colostomyis a surgical procedure that opens the colon (the longest part of the large intestine) outside of the abdominal wall. Part of the colon or rectum disease process or damaged area of ​​the colon (for example Colon cancer) is removed, a colostomy occurs.

What is an ileostomy?

Ileostomyis the procedure that allows the ileum (the last part of the small intestine) to open out of the abdominal wall.

The opening created by colostomy or ileostomy STOMA It called. What are impacted teeth? When one or more teeth fails to grow in the correct position and is therefore held below the normal gum line, it is called an impaction. This can be complete, such as completely unerrupted (buried) third molars (wisdom teeth) or partial when just part of the tooth is visible in the mouth. Why are impactions important? For best function and appearance the teeth should grow in a healthy alignment. When one or more teeth is impacted, this can affect the function of that tooth but also the function and appearance of other teeth. Whether all impactions should be treated is still controversial and your dentist and oral and maxillofacial team can explain the advantages and disadvantages or treatment for you, which is usually surgical.

A colostomy or ileostomy temporary (Temporary) or permanent It could be (Permanent). The doctor may perform a temporary colostomy or ileostomy to allow the bowels to rest and heal after surgery. If the lower part of the rectum and anal sphincter are removed, the colostomy or ileostomy will be permanent.

A colostomy or ileostomy may also be called a bowel diversion (Bowel Diversion).

Why is a colostomy or an ileostomy done?

A colostomy or ileostomy is performed when part of the bowel needs to be removed or bypassed (bypass). This can be done as part of the treatment in the following situations:

  • colorectal, anal, or ovarian cancers
  • ulcerative colitis or Crohn's disease an inflammatory bowel disease such as IBD
  • familial adenomatous polyposis (FAP)
  • obstruction in the intestine (called bowel obstruction, ileus, obstruction)
  • injury to the intestines
  • Small bags that form and become inflamed in the intestinal lining (diverticulitis called)
  • birth defects
  • Stool Incontinence Disease (Fecal Incontinence)
  • Next peri-anal fistula in cases.

Places where a colostomy or ileostomy is performed

Performing a colostomy or ileostomy will depend on the part of the intestine affected by the disease. Different colostomies are named based on where they are in the colon.

Sigmoid colostomy It is done in the sigmoid colon, which is the last part of the colon that connects to the rectum. It is the most common type of colostomy.

Descending colostomy (dessendan) is made in the descending colon, which is the part of the colon that descends from the left side of the abdomen.

Transverse colostomyis done in the transverse colon, which is the middle part of the colon that runs through the upper abdomen.

Ascending colostomy (ascendan) is done in the ascending column, which is the first part of the column. It starts from the cecum and goes up to the right side of the abdomen. A ascending colostomy is uncommon because an ileostomy is preferred instead.

Which is the last part of the small intestine ileostomy in the ileum makes.

Scheme of the colostomy sites

Performing a colostomy or ileostomy will affect the type and consistency of stool. The colon normally absorbs water. When part or all of the colon is removed or bypassed, water cannot be absorbed from the stool as usual. For example, stool from an ileostomy is mostly liquid because it doesn't pass through the colon, which normally removes most of the water. If you have a descending or sigmoid colostomy, the stool will be formed and firm as usual.

Colostomy and ileostomy types

A colostomy or ileostomy can be done in different ways depending on why it's needed. Your doctor will decide which colostomy or ileostomy is best for you.

End (end) Colostomy or Ileostomy

A colostomy or ileostomy attaches one end of the colon or ileum to an opening in the abdominal wall. An end colostomy is often performed in the sigmoid colon. An end ileostomy is often performed in the last part of the ileum. The rest of the colon can be removed completely.

End Stoma with a rectal stump

An end colostomy or an ileostomy can be performed with a rectal stump. This surgery also Hartmann procedure It can also be called. The rectum and anus remain in place and the cut end is closed with staples or stitches. The rectal stump is not functional (stool does not pass through), but mucus may still come out from the anus. This type of colostomy or ileostomy may be temporary. After the bowel has healed, the doctor can connect the remaining bowel to the rectum.

End colostomy with mucus fistula

An end colostomy with a mucus fistula can also be a double barrel or double barrel (double-barrel) is called a colostomy. It is usually done when part of the transverse colon or descending colon is removed and the sigmoid colon, rectum, and anus are not removed. This type of colostomy is created with 2 stomata. Part of the colon is removed and each cut end of the colon is attached to a separate opening in the abdominal wall. A stoma is created from the first part of the colon on the right side of the body. Because stool passes through it, it is called a functional stoma or end stoma. A second stoma called mucus fistula is created from the last part of the colon. A mucus fistula pushes mucus out of the body.

Loop colostomy or ileostomy

A loop colostomy or ileostomy is usually temporary. Stool is made in such a way that it leaves the body before it reaches the diseased or injured part of the intestines. After the bowel has healed, it can be reconnected. To create a loop colostomy or ileostomy, the doctor takes part of the colon or ileum out of the abdominal wall and inserts a plastic rod through the loop to keep it from slipping back into the abdomen. Sometimes a skin flap is used instead of a plastic stick. He then makes a partial incision (not cut completely) in the colon or ileum. The 2 sides of the opening become a stoma above the abdomen. Stool and mucus leave the body from the stoma. Some stool and mucus also comes out through the anus.

Colostomy and ileostomy types

Preparing for a colostomy or an ileostomy

Before surgery, your healthcare team will run tests to check your overall health and to make sure you can have surgery.

Your doctor or healthcare team will tell you if you need to follow a special diet before surgery. Your healthcare team will also tell you when to stop eating and drinking prior to surgery.

You may need to cleanse the bowel before surgery. This usually involves taking a laxative-type cleansing preparation 1-2 days before surgery. Cleansing enemas may be given in the hospital to make sure the colon is as empty as possible.

Your surgeon will usually mark the abdominal area to ensure that the stoma is in a suitable and comfortable place. Your surgeon or healthcare team can also discuss the type of pouch (also known as an ostomy device) you should use after surgery. You may be given antibiotics just before the surgery to help prevent infection.

How is a colostomy or an ileostomy done?

Colostomy or ileostomy can be done in a hospital under general anesthesia (GA).

The surgeon may use an open or laparoscopic technique. With the open technique, the surgeon makes an incision (incision) in the abdomen to reach the intestines. With the laparoscopic technique, the surgeon makes small incisions in the abdomen and then inserts an endoscope (a thin, tube-like instrument with light and lenses, laparoscope) and instruments to perform the surgery. The open technique is more commonly used for colostomy or ileostomy than the laparoscopic technique.

During surgery, some parts of the intestines need to be mobilized. This means that the surgeon can cut and move and stretch the membranes that hold the bowels in place.

Depending on why the surgeon needs to perform a colostomy or an ileostomy, bowel resection may be performed first. Intestinal resection is used to completely remove the diseased or damaged part of the intestine. For more information on bowel resection: Bowel Rot

To create a final colostomy or ileostomy, the surgeon brings one end of the colon or ileum to an opening in the anterior abdominal wall and mouth. The surgeon stitches the edges of the incised portion of the colon or ileum into the skin of the abdomen to make a stoma. It closes the other cut end of the colon or ileum with stitches or staples. For ileostomy with a colostomy or mucus fistula, the other cut end of the colon or ileum is attached to another part of the abdomen to make a second stoma.

For a loop colostomy or ileostomy, the surgeon stitches the cut edges of the colon or ileum to the skin through 2 openings in the abdominal wall.

The surgeon may insert a tube (drain) into the abdomen to drain fluids. This helps prevent infection and allows the area to heal.

A special pouch called an ostomy device is placed around the stoma (Colostomy or ileostomy bag). This pouch collects stool that passes through the body through the stoma.

Side effects

Side effects can be seen in all kinds of surgery, but everyone's experience is different. Some people have many side effects. Other people have little or no.

Side effects of a colostomy or an ileostomy include:

  • Pain
  • bleeding
  • infection
  • blood clots
  • hernia near the stoma (stomal hernia, incisional hernia)
  • stoma falling into the abdomen (stoma retraction)
  • bowel leaving more of the stoma than expected (called stoma prolapse)
  • Damage to nearby organs
  • dehydration, which is more likely with an ileostomy
  • a blockage in the intestine caused by scar tissue (called an intestinal blockage)

After surgery

You may need to stay in the hospital for a few days after the surgery. Pain medication, epidural anesthesia, or both will be given to make you comfortable. These medications are usually given through an intravenous needle (intravenous or IV) or an epidural catheter.

You will be given clear fluid 1-2 days after the operation. Solid foods and foods will be started slowly.

The stoma usually swells right after surgery. It is soft, moist and reddish pink in color, just like the lining in the mouth. There is no feeling in the stoma, so it does not cause pain when touched. There are many blood vessels on the surface of the stoma, so if you rub or wipe too hard it may bleed a little.

If you have a colostomy or an ileostomy, you cannot control bowel movements. You should always wear a pouch for ostomy.

While in the hospital, a specially trained healthcare professional called an enterostomal therapist will teach you how to live and care for a colostomy or ileostomy. Before you go home, the medical team or enterostomal therapist will discuss some situations with you:

  • changing bandages or dressing
  • shower and bath
  • How and when to use the medicines you need
  • eating and drinking
  • physical activity
  • what to do if you have problems
  • when to visit the surgeon for follow-up
  • If you have had a bowel resection to remove cancer, you may need more treatment. A referral may be made to a doctor who specializes in cancer treatment (called an oncologist).

If the colostomy or ileostomy is temporary, your healthcare team will talk to you about how much time you will need. A temporary colostomy or ileostomy is usually in place for several months (2-6 months). Once the rest of the large intestine has healed, you will have another surgery to rejoin the ileum or 2 ends of the colon. This processing anastomosis ve Colostomy or ileostomy closure called. The surgeon also closes the opening in your abdomen. You will continue to defecate normally after this second surgery.

Managing your diet

Most people who have a colostomy or ileostomy will be able to eat as they did before surgery. You may need to make some changes in your diet to help you manage the following issues.

Gas

Gas can be caused by some foods and drinks. It can be difficult to control and can be embarrassing at times.

You can help control gas by eating regular meals and chewing your food slowly. You may want to limit foods that can cause gas, including:

  • dried beans and peas
  • Broccoli
  • cabbage
  • cauliflower
  • onion
  • melon
  • strong cheeses
  • carbonated drinks

Smell

Some foods may cause odor from the pouch or ostomy appliance. You may want to limit foods that can cause odor, including:

  • onion
  • cabbage
  • Turnip
  • Garlic
  • dried peas and beans
  • eggs
  • fish
  • fried foods
  • Certain foods, such as yogurt, buttermilk, and parsley, can help control odor. You can also add deodorants to the scrub to control odor.

Talk to your enterostomal therapist if you are concerned about the smell of the bag.

You can check the link here about changing the colostomy bag: Bag Change

Obstruction and Irritation in the Stoma

Sometimes a narrowing may occur near the colon or ileum stoma. Some foods can become trapped in the narrowed part of the colon or ileum, causing a blockage or strain. The same foods can also cause the stoma to become swollen and irritated. Obstruction in an ileostomy is more likely than a colostomy.

Drinking too much fluid can help prevent congestion. You may also want to limit certain foods that are clogging or irritating, such as:

  • nutrients with seeds, such as raspberries, strawberries, and tomatoes
  • Hazelnut
  • Popcorn
  • coconut
  • Misir
  • celery
  • Pineapple
  • apple peel

Nausea If you have vomiting or vomiting and nothing comes from your stoma, tell your doctor or healthcare team right away. These symptoms could mean that you are congested.

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