COLOSTOMY

Colostomy: surgical opening into the colon by means of a stoma to allow

drainage of bowel contents; one type of fecal diversion

A colostomy is the surgical creation of an opening (ie, stoma) into the

colon. It can be created as a temporary or permanent fecal diversion. It allows
the drainage or evacuation of colon contents to the outside of the body. The
consistency of the drainage is related to the placement of the colostomy, which is
dictated by the location of the tumor and the extent of invasion into surrounding
tissues. With improved surgical techniques, colostomies are performed on fewer
than one third of patients with colorectal cancer.

INDICATION

The elderly are at increased risk for complications after surgery and may
have difficulty managing colostomy care. They may have decreased vision,
impaired hearing, and difficulty with fine motor coordination. It may be helpful for
the patient to handle ostomy equipment and simulate cleaning the peristomal
skin and irrigating the stoma before surgery. Skin care is a major concern in the
elderly ostomate because of the skin changes that occur with agingthe
epithelial and subcutaneous fatty layers become thin, and the skin is irritated
easily. To prevent skin breakdown, special attention is paid to skin cleansing and
the proper fit of an appliance. Arteriosclerosis causes decreased blood flow to the
wound and stoma site. As a result, transport of nutrients is delayed, and healing
time may be prolonged. Some patients have delayed elimination after irrigation
because of decreased peristalsis and mucus production. Most patients require 6
months before they feel comfortable with their ostomy care.