Loop Colostomy

What is a loop colostomy?

A colostomy is a procedure that severs your colon and diverts the upper part to a new artificial opening in your abdominal wall, called a stoma. A loop colostomy is the most common type of colostomy performed, and it’s usually temporary. Because the loop method makes the colostomy easier to reverse, it’s the operation of choice when your bowel only needs a temporary intervention to heal. You may have a loop colostomy for a few weeks, months or years depending on your condition.

When is a loop colostomy indicated?

The two main purposes for a temporary loop colostomy are diversion and decompression.

Diversion means keeping poop (feces) out of a certain section of your colon that needs to rest and heal. You may need a diverting loop colostomy if your colon is recovering from injury, surgery or infection. The colostomy diverts your poop away from the site of the trauma to avoid contamination and give that part of your colon some relief from its usual duties.

Decompression means there’s an obstruction in your colon that needs to the removed and relieved. A decompressing loop colostomy allows you to continue to move your bowels through your stoma while the lower part of your bowel is temporarily out of commission. Removing a blockage usually requires surgery, and that means the affected part of your colon will need to heal afterward. When it has recovered, your bowel can be reconnected.

What conditions does a loop colostomy help treat?

Some examples of conditions that may require a loop colostomy include:

• Diverticulitis.
• Ulcerative colitis.
• Crohn’s disease.
• Large bowel obstruction.
• Partial colectomy.
• Severe anorectal or perineal injury or infection.

What is the difference between a loop colostomy and an end colostomy?

These are the two general types of colostomies performed. A loop colostomy is usually temporary, while an end colostomy is performed when your condition is considered irreversible. The difference between them is mainly in what happens to the two ends of your colon after it’s severed.

In a loop colostomy, the surgeon pulls a loop of bowel through the opening in your abdominal wall and then partially severs the loop. They leave both ends poking out of the opening in your abdomen while they’re still connected. The upper end, which is still connected to your small intestine, is where your poop will come out. The lower end, which is connected to the lower part of your bowel, excretes the mucous that’s normally produced there.

In an end colostomy, only the upper end of your bowel is brought to the opening in your abdomen. It’s stitched there to hold it permanently in place. The lower end is usually stitched shut and left inside your body as a blind pouch. In some cases, it may be brought to a different opening or stoma to secrete mucus (double barrel colostomy). In other cases, the entire lower portion of your bowel might need removing.

What is the difference between a loop colostomy and a loop ileostomy?

The difference is in which part of your intestines is being redirected to an ostomy. A colostomy redirects your colon, or large intestine. An ileostomy redirects your small intestine — specifically, the last part that connects to your large intestine, which is called the ileum. The procedure is otherwise the same. Like a loop colostomy, loop ileostomy is intended to be temporary.

Are there different types of loop colostomies?

Healthcare providers talk about the colon in terms of different sections. There’s no real separation between the sections, but they travel in different directions. When it comes to colostomies, the section of your colon that gets severed and redirected will make some difference to the surgeon, and to you. (It affects where your stoma is placed and how liquid or solid your poop will be.) For this reason, your healthcare provider may discuss your colostomy in terms of the section, as well as the method (loop colostomy).

An ascending loop colostomy redirects the ascending colon, the first part of your colon that travels up the right side of your abdomen. A transverse loop colostomy redirects the transverse colon, the part that travels horizontally across your abdomen from the right side to the left. A descending loop colostomy redirects your descending colon, which travels down the left side. A sigmoid loop colostomy redirects the last part of your colon, the “tail” that hooks down and to the right of the descending colon.

What happens before a loop colostomy?

Before the surgery, you’ll have what’s called a pre-operation assessment meeting with your surgeon. They’ll make sure you fully understand the procedure, the risks involved and the lifestyle changes you’ll have to adopt afterward before you sign your consent forms. You may take some basic diagnostic tests to make sure you’re well enough for surgery. You may also discuss your pain management options at this time.

On the day of the surgery, you’ll be asked not to eat or drink anything for six hours prior. You may be given an enema or bowel prep to clear your bowels at home before the procedure. When you arrive at the hospital, you’ll be led to a pre-op room, where you’ll change into a hospital gown and wait for your operation. Once you’re in the operating room, you’ll receive anesthesia.

What happens during a loop colostomy?

Depending on your condition, your loop colostomy may be performed by laparoscopic surgery or open surgery. Laparoscopic surgery is a less-invasive method that’s performed through micro-incisions with the use of a tiny lighted camera called a laparoscope. Open surgery uses one large incision to open your abdomen and access your organs (laparotomy). Laparoscopic surgery is preferred when possible because it’s easier on the person receiving surgery. However, emergencies and more complicated conditions may require open surgery to manage.

For both procedures, you’ll be put to sleep under general anesthesia. Laparoscopic surgery begins with a small incision that’s used to inflate your abdominal cavity with carbon dioxide gas. This helps separate your abdominal wall from your organs, making them easier to see. Then, the camera (laparoscope) is placed in the portal to project your organs onto a screen. The camera will guide the placement of one or two additional micro-incisions. If you’re having open surgery, a single large incision will open your abdomen.

The location site for your stoma will be already marked on your body. Your surgeon will make an incision for the stoma, identify where your colon needs to be divided and bring the bowel loop through the incision. They’ll partially sever the loop and place the two open ends side-by-side in the stoma. To attach them, your surgeon folds back the sheath of your intestine and stitches the folded edge to your skin. Sometimes, they place a temporary support rod between the two ends, which is removed in a few days.

What happens after a loop colostomy?

After the procedure, you’ll be taken to a post-operative room until you wake up from your anesthesia. Then, you’ll spend the next few days recovering in the hospital. The length of your stay may vary depending on your condition and whether you had laparoscopic surgery or open surgery.

During your recovery, you’ll:

• Resume normal eating gradually. You’ll probably be fed a clear liquid diet for the first day after surgery, then progress to a full liquid diet or soft diet before resuming solid food.
• Learn all about colostomy care. A wound ostomy continence nurse (WOCN) will teach you all about living with a colostomy bag and how to care for your stoma.
• Gradually wean from your pain medications. You may be given a short-term prescription to take home with you.
• Heal from your wounds, and your bowel movements will begin to regulate. It may take several days before your first one.

What does a loop colostomy look like?

The first time you see your colostomy, it may look large, red and swollen. This is temporary. It will change a lot as it heals. Eventually, it’ll look like two roundish, pinkish rings placed together. It may look a little different from person to person. The rings may look puffier or flatter, rounder or more oblong. They may look more like one large opening than two. Your stoma may be placed higher or lower depending on where your colon was divided.

What are the advantages of loop colostomy?

The purpose of a temporary colostomy is to allow your colon to rest and heal from significant illness, injury or surgery without risking further complications. The colostomy itself is secondary to this necessary healing, but it’s what makes that healing possible and allows your body to continue to function in the meantime. The loop method allows the colostomy to be safely reversed when your colon has healed. The two ends of your bowel, still partially connected in your stoma, are easily fully reconnected to restore normal bowel function.

What are the risks or complications of this procedure?

The procedure itself is usually uncomplicated, but it carries the typical risks of any surgery, including:

• Reactions to the anesthesia.
• Breathing problems under anesthesia.
• Injury to nearby organs.
• Infection.

You may encounter complications with your colostomy after the procedure. Some of these include:

• Skin irritation from contact with stool, especially the acidic, liquid stool of your upper colon. This is the most common stoma complication. It can usually be solved with a better-fitting bag.
• Bowel obstructions from scar tissue or paralytic ileus (slow-moving bowels) after the surgery, preventing poop from passing. This can usually be solved with home constipation remedies.
• Stoma retraction or prolapse. A retracted stoma sinks back below your skin surface level. A prolapsed stoma sticks out too far. Both situations can make it difficult to fit the colostomy bag securely to the stoma. If you can’t find a bag that fits, your surgeon may have to re-site or revise your stoma.
• Parastomal hernia. This type of hernia occurs when loops of bowel bulge through weakened abdominal muscles around your stoma. A hernia forms a visible bulge next to the stoma and can grow over time, potentially blocking your stoma’s output. Your colostomy nurse will talk to you about steps you can take to prevent a hernia from developing after the surgery.

When can a loop colostomy be reversed?

This will depend on your health. You’ll need to be fully recovered from both the surgery and the condition that caused you to need surgery in the first place. Some people are ready within weeks or months after their loop colostomy surgery, and others may not be ready for several years. Your healthcare provider will monitor your condition during follow-up visits after your operation. They’ll schedule your reversal surgery when you both feel you’re ready.

When should I see my healthcare provider about my colostomy?

Contact your general care provider or ostomy nurse if you experience:

• Persistent constipation or diarrhea.
• Persistent nausea or vomiting.
• Blood in your stool.
• A change in your stoma’s regular size or color.
• Any strange foul odors coming from your stoma.
• A blockage in your stoma.

A note from Cleveland Clinic

A loop colostomy is a temporary intervention to redirect your colon to a stoma in your abdomen. Diverting your poop to a new route out of your body allows your traumatized colon to rest and heal. Adjusting to life with a colostomy is a significant challenge, but in this case, it’s a temporary one, often with lifesaving benefits. A loop colostomy is easily reversed when you and your colon have recovered from the original trauma and the surgery.