Type of Surgery
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Last updated: 11/24/2009
Postoperative care for the patient with a new colostomy, as with those who have had any major surgery, involves monitoring of blood pressure, pulse, respirations, and temperature. Breathing tends to be shallow because of the effect of anesthesia...
and the patient's reluctance to breathe deeply and experience pain that is caused by the abdominal incision. 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. The nasogastric tube will remain in place, attached to low, intermittent suction until bowel activity resumes. For the first 24–48 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. Usually within 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.
A colostomy pouch will generally have been placed on the patient's abdomen around the stoma during surgery. During the hospital stay, the patient and his or her caregivers will be educated on how to care for the colostomy. 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 attach the pouch. Some patients with colostomies are able to routinely irrigate the stoma, resulting in regulation of bowel function; rather than needing to wear a pouch, these patients may only need a dressing or cap over their stoma. Often, an enterostomal therapist will visit the patient in the hospital or at home after discharge to help the patient with stoma care.
Dietary counseling will be necessary for the patient to maintain normal bowel function and to avoid constipation, impaction, and other discomforts.
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To perform a colostomy, the surgeon enters the abdomen and locates the colon, or large intestine (A). A loop of the colon is pulled through the abdominal incision (B); then the colon is cut to allow the insertion of a catheter (C). The skin and tissues are closed around the new opening, called a stoma (D). (Illustration by GGS Inc.)
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A colostomy is a surgical procedure that involves connecting a part of the colon onto the anterior abdominal wall, leaving the patient with an opening on the abdomen called a stoma. In a colostomy, the stoma is formed from the end of the large intestine, which is drawn out through the incision and sutured to the skin. After a colostomy, feces leave the patient's body through the abdomen. A colostomy may be permanent or temporary, depending on the reasons for its use.
There are many reasons for this procedure. Some common reasons are:
A section 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 faeces to pass out via the anus.
A portion of the colon (or ileum) 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 tumors commonly are given a colostomy in preparation for surgery to remove the tumor, followed by reversal of the colostomy.
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