Diverticular disease involves the formation of small, bulging pouches called diverticula in the wall of the digestive tract. When these pouches become inflamed or infected, the condition progresses to diverticulitis. A colostomy is a surgical procedure that reroutes the large intestine through an opening in the abdominal wall, creating a stoma, typically done to bypass or remove a diseased segment of the colon. Many patients wonder if this inflammation can develop or recur after the initial surgery. This article explores the possibility of post-colostomy diverticulitis and the specific risk factors for people living with a stoma.
Understanding Diverticulitis and the Colon
Diverticulitis is exclusively a disease of the large intestine, or colon. The condition begins with diverticulosis, where small, sac-like herniations push outward through weak spots in the muscular layer of the colon wall. This process is often related to high pressure within the colon, such as from straining during bowel movements. Diverticula are most commonly found in the sigmoid colon. When fecal matter or bacteria become trapped in these pouches, it leads to inflammation, infection, and sometimes perforation. The pathology depends entirely on the presence of colon tissue. A colostomy involves surgically bringing a section of the colon to the surface of the abdomen, creating an exit point for waste. This rerouting is often performed to allow a damaged section of the bowel to heal or to remove it entirely.
Risk Assessment After Colostomy
The risk of experiencing a new episode of diverticulitis after a colostomy depends entirely on the extent of the original surgery. If a patient has undergone a total colectomy, meaning the entire colon has been removed, the risk of future diverticulitis is eliminated. Diverticulitis cannot occur in the small intestine, but it can occur in any remaining large bowel tissue, including the segment used to form the stoma.
Many colostomy procedures are partial colectomies, where only the most diseased segment is removed, and a portion of the large bowel remains. This remaining segment, whether it is the transverse, ascending, or descending colon, is still susceptible to the formation or inflammation of diverticula. For instance, in a Hartmann’s procedure, the rectum and a distal colon stump are left inside the body. This tissue remains colonic and is still at risk for inflammation.
Diverticulitis can even develop in the segment of the colon brought through the abdominal wall to form the stoma, known as end-colostomy diverticulitis. This occurs because the stoma tissue is still large intestine. If diverticula were present in that section or form later, they can become inflamed. Residual diverticula in any remaining large bowel tissue, whether internal or externalized, pose a risk for recurrence.
Recognizing Symptoms with a Stoma
A challenge for patients with a colostomy is that typical diverticulitis symptoms can be masked or altered due to the surgical rearrangement. The classic symptom of localized lower left abdominal pain may be less distinct, replaced by discomfort around the stoma site or the remaining colon segment. This altered presentation can lead to a delayed diagnosis, as the pain might be mistaken for other stoma complications like a hernia or skin irritation.
Fever, nausea, and abdominal tenderness remain indicators of an inflammatory process. A specific sign to monitor is a significant change in stoma output. A flare-up in the remaining colon might cause a sudden decrease in output volume, or a change in consistency, such as becoming watery or unusually thick. Tenderness or swelling directly around the stoma or the remaining colon area can also signal localized inflammation. Any persistent, unexplained pain or systemic symptoms like fever and chills should prompt immediate consultation with a healthcare provider.
Treatment and Prevention Strategies
Treatment for diverticulitis in a patient with a colostomy follows the same principles as for any other patient, but requires careful adaptation. Mild cases are managed with bowel rest, often involving a liquid or low-fiber diet, and antibiotics to clear the infection. For the ostomy patient, managing output during bowel rest is crucial, and hydration needs must be monitored, as a liquid diet can increase output and the risk of dehydration.
Prevention focuses on maintaining optimal bowel health to reduce pressure within the remaining colon. A high-fiber diet is recommended to keep stool soft and moving quickly, reducing the chance of fecal matter trapping in a diverticulum. Ostomy patients must manage fiber intake cautiously to avoid food blockages at the stoma, often requiring thorough chewing. Adequate fluid intake is also important for preventing constipation and ensuring smooth stoma function. Regular follow-up with a surgeon, gastroenterologist, and an ostomy nurse is recommended to monitor the health of the remaining colon and provide tailored guidance.