Colostomy is a digestive surgery that connects a segment of the colon to the abdominal wall through a small opening. Carried out when part of the colon must be removed or bypassed, the colostomy will be temporary or permanent as indicated.

From “colo” for colon, and “stoma” meaning opening in Greek, colostomy or “artificial anus” in common parlance, is a surgical procedure consisting in connecting a segment of the colon to a stoma (an opening) made on the wall. abdominal. This opening makes it possible to evacuate the stool, collected in a special pocket stuck on the belly. Colostomy can be temporary or permanent.

Depending on the site of the colostomy, we can distinguish:

• sigmoid colostomy, performed in the sigmoid colon, the last part of the colon connected to the rectum. This is the most common type of colostomy;
• descending colostomy, performed in the descending colon, along the left side of the abdomen;
• transverse colostomy, at the level of the transverse colon, the central part of the colon along the upper abdomen;
• ascending colostomy, in the ascending colon, the first part of the colon.

In addition, different colostomy techniques exist:

• terminal colostomy: the colon is connected to an opening made in the abdominal wall;
• terminal colostomy with rectal stump or “Hartmann’s intervention”: the rectum and anus remain in place, and their ends are sutured. The rectum is not functional but in the event of a temporary colostomy, the end of the colon can be connected again to the rectum which will regain its function;
• terminal colostomy with mucous fistula: also called double-ended colostomy, it is performed in the event of a transverse or ascending colostomy. It has two stomas: a first on the right side, leading to the first part of the remaining colon. This is the functional stoma: it is through it that stools are evacuated. The second is connected the last part of the colon in place. It is called mucous fistula because it allows mucus to be evacuated;
• lateral colostomy: also called lateral colostomy on a subcutaneous rod, it consists in making a loop out of the colon through an incision in the abdomen, in placing a rod in the loop to hold it in place then in making an incision in the colon, without opening it completely. The two parts of the colon thus opened then form the stoma.

Colostomy can be decided on an emergency basis, or it can be elective (scheduled). It can be preceded by a resection of part of the colon, or be performed in isolation.

When scheduled, the patient should take 1 or 2 days before surgery a laxative preparation aimed at emptying the intestines, possibly supplemented by cleansing enemas in the hospital.

The operation takes place under general anesthesia, under laparotomy (opening the abdomen) or laparoscopy (small incisions are made on the abdomen to introduce the endoscope and surgical instruments).

The colon segment is connected to the skin of the abdomen, and fixed with absorbable suture. A self-adhesive pocket, which can be emptied, is positioned around this orifice.

A colostomy is done when part of the intestine needs to be removed or bypassed.

A temporary colostomy may be indicated for:

• colonic occlusion: the transit through the anus no longer takes place. This can happen with sigmoid colon cancer. The operation then takes place urgently;
• peritonitis by perforation of a diverticulum (emergency);
• certain inflammatory bowel diseases (certain severe forms of Crohn’s disease, ulcerative colitis), pending the consolidation of the disease;
• in the event of colon resection (for colorectal cancer in particular) when the surgeon considers that the inflammation is too great to immediately connect the two segments of the remaining colon, or that the operation took place in emergency without preparation of the intestine. The colostomy then allows the colon to rest. The colorectal anastomosis, that is to say the suture between the colon and the rectum, will be performed during a second operation.

Definitive colostomy may be necessary in case of:

• certain colorectal cancers: if the tumor is too close to the sphincter, it is necessary to remove the rectum and anus;
• certain genital cancers with invasion of the rectum.

Operative suites

Hospitalization lasts a few days. 

An analgesic is administered intravenously, possibly supplemented with an epidural anesthetic. The feed is first liquid, then the solids are gradually reintegrated.

It is normal for the stoma to be swollen in the days following the procedure. It can even bleed a little because it is highly vascularized on the surface, but it is not painful because it contains very little nerve tissue.

A few weeks after the operation, the colostomy takes on its final appearance: bright red, it forms a circle a few centimeters in diameter and comes out a little on the surface of the skin.

Daily life with a colostomy

In the hospital, a specialist called an enterostomy therapist informs the patient about the care to be given to the ostomy, bag changes, diet and lifestyle. A psychological follow-up is also strongly recommended, because the ostomy can have a strong psychological impact because of the bodily and intimate damage it represents.

Depending on the segment of the colon affected by the stoma, the consistency of the stool will be different. The closer you are to the rectum, the more solid and molded the stool will be. These stools are collected in an airtight bag with an adhesive part (the skin protector) and a filter to deodorize and evacuate gases. Disposable, the bag must be changed on average every day. When changing the pouch, cleaning of the stoma is necessary, but not disinfection, because the stoma is not a wound.

Some dietary precautions should be observed: eat calmly, chew well, drink regularly throughout the day, avoid certain foods that tend to ferment, have a strong odor or may clog the stoma.

Little by little, the patient can resume a normal life, have a married life, play sports, travel, with some adjustments taking into account the presence of this pocket.

After a temporary colostomy

After a period varying from 6 to 12 weeks, an operation is scheduled for the anastomosis: the stoma is closed and the intestinal continuity is re-established, again allowing stool to be evacuated by natural means.

Risks and complications

Different complications can arise with a colostomy:

• infection (stoma abscess);
• necrosis of the stoma;
• the formation of a hernia near the stoma;
• refraction of the stoma (it sinks into the abdomen);
• prolapse (the colon comes out of the stoma);
• bowel obstruction caused by scar tissue;
• obstruction and inflammation of the stoma from certain foods;
• a yeast infection in the stoma.

Some of these complications may require revision surgery.