Diverticulitis is a common digestive condition involving the formation of small, bulging pouches called diverticula in the lining of the large intestine. When these pouches become inflamed or infected, the condition is termed diverticulitis, causing symptoms such as abdominal pain, fever, nausea, or changes in bowel habits. While many cases are managed with antibiotics and dietary adjustments, severe instances may necessitate surgical intervention. A common concern for individuals facing this surgery is whether it will result in a colostomy bag. This article clarifies when a colostomy might be required following diverticulitis surgery and what to anticipate.
Understanding Diverticulitis Surgery
Surgery for diverticulitis typically involves removing the diseased section of the colon, a colectomy or bowel resection. The most common type is a sigmoid colectomy, as diverticula frequently form in the sigmoid colon. After removing the diseased segment, the surgeon usually reconnects the remaining healthy ends of the colon through primary anastomosis. This rejoining allows for normal bowel function to resume.
Surgical approaches vary, including open surgery with a larger incision, or laparoscopic surgery using small incisions and specialized instruments. Laparoscopic surgery generally results in less trauma, reduced pain, and quicker recovery. The choice of method depends on the condition’s severity, patient health, and surgeon assessment. These procedures aim to alleviate symptoms, prevent recurrence, and address complications.
When a Colostomy is Necessary
A colostomy is not always part of diverticulitis surgery; it’s typically reserved for complex or emergency situations where immediate bowel rejoining is unsafe. A primary reason is bowel perforation, a hole in the colon wall allowing intestinal contents to leak into the abdominal cavity. This can lead to peritonitis, a serious abdominal infection. A colostomy diverts stool away from the perforated area, allowing the colon to heal without contamination.
Severe infection, such as a large abscess or widespread inflammation, can also make immediate rejoining of the bowel risky. If the bowel tissue is inflamed, unhealthy, or fragile, an anastomosis might not heal properly, potentially leading to a leak. Additionally, if a patient presents with a bowel obstruction or experiences significant, uncontrolled bleeding from diverticula, a colostomy may be necessary to manage these complications.
In these emergency scenarios, surgeons often perform a Hartmann’s procedure. This involves removing the diseased portion of the colon and bringing the healthy end of the remaining colon through an opening in the abdominal wall, forming a stoma. This stoma connects to an external colostomy bag. This two-stage approach allows the patient to stabilize and the colon to recover before a second surgery to reverse the colostomy.
Temporary or Permanent: What to Expect
Most colostomies created after diverticulitis surgery are temporary. They allow the inflamed or damaged bowel to heal before reconnection. The duration for a temporary colostomy varies, but it is often reversed in a second surgery, usually several months later, once the patient has recovered and the bowel has had sufficient time to heal. This reversal rejoins the two ends of the colon, restoring normal bowel function.
Factors influencing whether a colostomy is temporary or permanent include the patient’s overall health, disease extent, and initial surgery complications. If a large section of the colon was removed, or if other significant health conditions make a second surgery too risky, the colostomy may be permanent. While many temporary colostomies are successfully reversed, some patients may not undergo reversal due to patient choice, comorbidities, or ongoing health issues.
Reversal surgery is generally performed when the patient is in stable condition, often between 6 weeks and 6 months after the initial procedure, though some reversals may occur later. A delay beyond 12 months has been associated with increased risks. The decision for reversal is made by the medical team and the patient, considering the benefits of restoring bowel continuity against the risks of another surgical procedure.
Living with a Colostomy
Adjusting to life with a colostomy involves learning how to manage the stoma and the external collection bag. The stoma, a surgically created opening on the abdomen, is typically red and moist and does not feel pain. A specialized pouching system, or colostomy bag, is worn over the stoma to collect stool and gas. These systems are designed to be discreet, odor-proof, and secure under clothing.
Routine care includes emptying the pouch when it is about one-third to half full and changing the entire pouching system regularly, typically every three to five days. Cleaning the skin around the stoma with water and ensuring it is dry before applying a new pouch is important to prevent skin irritation. With proper care and guidance from healthcare professionals, individuals with a colostomy can typically return to most of their normal activities, including showering, swimming, and various forms of exercise. Dietary adjustments may be recommended to manage gas or stool consistency, but many people find they can return to a varied diet.