Colostomy / Ileostomy—Child
Definition
An ostomy is a surgical procedure that connects an internal organ to the surface of the body. An artificial opening called a stoma is created to allow waste to exit the body and pass into an external bag.
The 2 types of ostomies discussed here include:
- Colostomy—brings the large intestine to the wall of the abdomen
- Ileostomy—brings the small intestine to the wall of the abdomen
Ostomies can be permanent, but they are often temporary in infants and children.
Reasons for Procedure
The intestines create a path for food to be digested and passed out of the body. An ileostomy or colostomy may be needed if the path through the intestines is interrupted. The interruption may be due to injury or illness of the intestine such as:
- Birth defects, such as spina bifida, Hirschsprung disease, and an imperforate anus
- Inflammatory bowel disease
- Trauma to the colon or rectum
- Cancer
- Serious infection
- Intestinal or bowel blockage that cannot be relieved with other methods
A temporary ostomy may be done to allow the intestine to rest after surgery, trauma, or illness.
A permanent ostomy may be needed if:
- A large area of intestine is removed
- The remaining lower intestine or rectum cannot be repaired
Possible Complications
Problems from the procedure are rare, but all procedures have some risk. Your child’s doctor will review potential problems, like:
- Adverse reaction to anesthesia
- Nausea and vomiting
- Sore throat
- Skin irritation
- Excess bleeding
- Infection
- Wound opening
- Hernia at the incision site
- Damage to nearby organs
- Scar tissue
- Bowel presses out of the stoma
- Heart attack
- Blood clots
- Nutritional deficiencies, particularly low levels of vitamins
Talk to your child’s doctor about ways to manage factors that may increase your child’s risk of complications.
What to Expect
Prior to Procedure
-
Your child’s doctor may do the following:
- Physical exam
- Blood and urine tests
- Imaging tests
- Refer you and your child to a nurse who specializes in ostomy patients
- Do give your child anything to eat or drink after midnight the night before the procedure.
- Certain medications may cause complications during the procedure or recovery. These medications may need to be stopped up to one week before the procedure. Talk to your child’s doctor before the procedure about all medications, herbs, and supplements your child is taking.
Anesthesia
General anesthesia will be used. It will block pain and keep your child asleep through the procedure. It is given through an IV.
Description of the Procedure
The exact steps will differ based on the specific reason for the surgery. Other work may need to be done before the ostomy is created. The surgery may be:
- Open—a larger incision is made in the abdominal wall so that the surgeon can view inside the abdomen
- Laparoscopic—a few small incisions are made that allow surgical instruments to pass into the abdominal cavity
An opening will be made through the muscle and skin of the abdominal wall.
If the intestine remains intact, a section of the intestine will be placed next to the opening in the abdominal wall. Incisions will be made in the intestine wall to create a second opening. The open area of the intestine will be pulled through the opening of the abdominal wall. The inner lying tissue of the intestine will be visible as the stoma.
If a section of the intestine has been removed, part of the remaining intestine will be pulled through the opening. The intestine end is secured outside the opening with sutures. This creates the stoma.
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Immediately After Procedure
After the operation, your child will be taken to the recovery room for observation.
How Long Will It Take?
How long the procedure takes depends on the reason your child needs to have the ostomy.
How Much Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is 3 days-1 week depending on the reason for the procedure. Your doctor may choose to keep your child longer if complications occur.
Post-procedure Care
At the Hospital
Right after the procedure, your child will be in a recovery room where their blood pressure, pulse, and breathing will be monitored. Care for the remainder of your child’s hospital stay may also include:
- Pain medications
- Antibiotics to prevent infection
- Medication to prevent blood clots
- Learning how to care for the ostomy, stoma, and pouch
- Receiving information about diet and activity
Depending on your child’s age, the hospital staff may ask your child to:
- Walk often after surgery
- Suck on ice chips
- Start with clear fluids and slowly advance to a regular diet
During your stay, the hospital staff will take steps to reduce your child’s chance of infection such as:
- Washing their hands
- Wearing gloves or masks
- Keeping your child’s incisions covered
There are also steps you and your child can take to reduce the chances of infection such as:
- Washing your hands often and reminding visitors and healthcare providers to do the same
- Reminding your child’s healthcare providers to wear gloves or masks
- Not allowing others to touch your child’s incisions
At Home
It will take about 6-8 weeks for the stoma to fully heal. There will be some changes needed to care for your child’s stoma and ostomy bag, but with practice it should not interfere with daily activities. Regular contact with your child’s medical care team will make sure your child is healing as expected and help manage any complications.
Call Your Child's Doctor
Call your child's doctor if any of these occur:
- Persistent nausea or vomiting
- Signs of infection, including fever and chills
- Lightheadedness
- Skin irritation
- Change in stool consistency
- Not passing any stool
- Blood in your child’s stool, or black, tarry stools
- Severe abdominal pain or cramps
- Change in the appearance of your child’s stoma, including narrowing or changes in color
- Bleeding from the stoma opening or in the pouch
- Blocked or bulging stoma
- New or unexpected symptoms
If you think your child has an emergency, call for emergency medical services right away.
RESOURCES:
National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov
United Ostomy Associations of America
https://www.ostomy.org
CANADIAN RESOURCES:
Health Canada
https://www.canada.ca
International Ostomy Association
http://www.ostomyinternational.org
REFERENCES:
Colorectal surgery considerations. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T900261/Colorectal-surgery-considerations. Accessed January 28, 2021.
Colostomy. Johns Hopkins Medicine website. Available at: https://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/colostomy_92,p07727. Accessed January 28, 2021.
For parents of children with ostomies. American Cancer Society website. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/ostomies/stomas-or-ostomies/getting-help-info-and-support1.html. Accessed January 28, 2021.
Ostomy. American Society of Colon and Rectal Surgeons website. Available at: https://www.fascrs.org/patients/disease-condition/ostomy-0. Accessed January 28, 2021.
Ostomy surgery of the bowel. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/ostomy-surgery-bowel. Accessed January 28, 2021.
Stoma care for children and their families. UCSF Benioff Children’s Hospital website. Available at: https://www.ucsfbenioffchildrens.org/education/stoma_care_for_children_and_their_families/index.html. Accessed January 28, 2021.
What is a colostomy or ileostomy? American College of Surgeons website. Available at: https://www.facs.org/~/media/files/education/patient%20ed/your%20colostomy.ashx. Accessed January 28, 2021.
Last reviewed March 2020 by EBSCO Medical Review Board Chelsea Skucek, MSN, BS, RNC-NIC Last Updated: 1/28/2021