The basic diagram on this slide shows the gastrointestinal tract, which consists, at the top, of the mouth down through the esophagus to the stomach, and on through to the small intestine. The small intestine is made up of three distinct sections, which start from the top with the duodenum, then down to the jejunum, and further still to the ileum. The small intestine meets up with the lower portion of the ascending colon, which is part of the large intestine. The large intestine consists of the ascending, transverse and descending colons, which wrap up, around and down to the rectum.

Colostomies may be located anywhere along the large intestine. They are usually created for the treatment of colon or rectal cancer, diverticulitis, trauma or congenital anomalies. A right-sided colostomy using the ascending colon is rare. An ileostomy is usually created when this section of the colon is affected. The consistency of the effluent (discharge) has been described as toothpaste-like and odorous.

A transverse colostomy is usually temporary with a loop or double-barrel stoma. It is located on the right or left side of the abdomen, usually in the area of the patient’s waistline. With a loop ostomy, there is one stoma that has two openings and there is a connecting wall between the proximal (draining or working) segment and the distal bowel. This type of colostomy may be required to treat cancer, diverticulitis, or traumatic injuries. With a double-barrel ostomy there are two separate and distinct stomas-the proximal functioning stoma and the distal non-functioning one. In this case, the bowel is cut in half. Consistency of the effluent ranges from a liquid consistency (immediate post-op), to a semisolid (mushy) consistency when in the outpatient setting. Effluent in this case is malodorous.

A descending colostomy is located on the left lower side of the abdomen. Reasons for placement may include colon cancer. The most common type of colostomy is placed with the sigmoid colon as a single-barrel or end colostomy and is found in the lower left quadrant of the abdomen. This type of colostomy may be created because of cancer. There is one stoma and the distal end of the GI tract has been removed. The effluent for both descending and sigmoid colostomies is much like the patient’s pre-surgical bowel movements. Patients with end descending or sigmoid colostomies may be able to use colostomy irrigation as a means to schedule their evacuation and be “continent”, only requiring a small pouch cap or cover between irrigations. Colostomy irrigation is contraindicated in the presence of parastomal hernia, stoma prolapse or history of radiation therapy to the bowel or pelvis.

Ileostomies are formed in the small intestine. Due to their location in the small intestine the patient may experience watery to oatmeal consistency stools amd may need to empty their pouch 5-8x/day. Caution should be exercised if there is no output within a 4-hour period. The patient should be sure to remind their doctor and pharmacist if they have an ileostomy as this may requre their meds to be adjusted. These types of ostomies are more prone to blockages--also, it should be noted, these patients are very prone to dehydration (which is their number 1 reason for re-hospitalization). It is important for these patients to drink 8-10 glasses of fluids/day.