Gastric, Intestinal, Colon and Rectal Procedures
Colorectal Cancer Screening
What Is a Colostomy?
Types of Colon Resections
Having Laparoscopic Colon Surgery
Laparoscopic Surgery of the Colon and Rectum (Large Intestine)
The above file is an Adobe PDF, which requires the Adobe® Reader®. Click the graphic below to get the free reader if you do not already have it.
Discharge Instructions for Colostomy
Incision Care: Abdomen
Colorectal Cancer Screening
Colorectal cancer (cancer in the colon or rectum) is a leading cause of cancer deaths in the United States. But it doesn’t have to be. When this cancer is found and removed early, the chances of a full recovery are very good. Because colorectal cancer rarely causes symptoms in its early stages, screening for the disease is important. It’s even more crucial if you have risk factors for the disease. Learn more about colorectal cancer and its risk factors. Then talk to your doctor about being screened. You could be saving your own life.
Risk Factors for Colorectal Cancer
Your risk of having colorectal cancer increases if you:
- Are 50 years of age or older.
- Have a family history or personal history of colorectal cancer or adenomatous polyps.
- Have a personal history of colorectal polyps, Crohn’s disease, or ulcerative colitis.
- Have a family history of multiple concurrent solid-tumor cancers.
The Colon and Rectum
Waste from food you eat enters the colon from the small intestine. As it travels through the colon, the waste (stool) loses water and becomes more solid. Intestinal muscles push it toward the sigmoid—the last section of the colon. Stool then moves into the rectum, where it’s stored until it’s ready to leave the body during a bowel movement.
How Cancer Develops
A DRE can detect a growth in the rectum or anus.
Polyps are growths that form on the lining of the colon or rectum. Most are benign, which means they aren’t cancerous. But over time, polyps can become malignant (cancerous). This occurs when cells in these polyps begin growing abnormally. In time, malignant cells invade more and more of the colon and rectum. The cancer may also spread to nearby organs or lymph nodes or to other parts of the body. Finding and removing polyps can help prevent cancer from ever forming.
Your Screening
Screening means looking for a medical problem before you have symptoms. During screening for colorectal cancer, your doctor will ask about your medical history, examine you, and do one or more tests.
History and Exam
- Medical History: Your doctor will ask about your medical history. Mention if a family member has had colon cancer or polyps. Also mention any health problems you have had in the past.
- Digital Rectal Exam (DRE): During a DRE, the doctor inserts a lubricated gloved finger into the rectum. The test is painless and takes less than a minute.
Possible Tests
- Fecal Occult Blood Test: This test checks for occult blood in stool (blood you can’t see). Hidden blood may be a sign of colon polyps or cancer. A small sample of stool is tested for blood in a laboratory. Most often, you collect this sample at home using a kit your doctor gives you. Follow the instructions carefully for using this kit. Avoid certain foods and medications before the test, as directed.
- Barium Enema with Contrast: This test uses x-rays to provide images of the entire colon and rectum. Bowel prep is also needed the day before this test. You will be awake for the test, but you may be given medication to help you relax. At the start of the text, a radiologist (a doctor who specializes in imaging tests) inserts a soft tube into the rectum. The tube is used to fill the colon with a contrast liquid (barium). The liquid helps the colon show up clearly on the x-rays.
- Scope Exams
Colonoscopy: This is the best test doctors have for finding and removing colorectal polyps. The day before the test, you will do a bowel prep to cleanse your colon. You will be given instructions for this. Just before the test, you are given a medication to make you sleepy. Then, a long, flexible, lighted tube called a colonoscope is gently inserted into the rectum and guided through the entire colon. Images of the colon are viewed on a video screen. Any polyps that are found are removed and sent to a lab for testing. If a polyp can’t be removed, a sample of tissue is taken and the polyp is removed later during surgery. A variation of this test, called virtual colonoscopy, may be an option. Your doctor can tell you more.
Sigmoidoscopy: This test is similar to colonoscopy, but focuses only on the sigmoid colon and rectum. As with colonoscopy, bowel prep must be done the day before this test. You are awake during the procedure, but you may be given medication to help you relax. During the test, the doctor guides a thin, flexible, lighted tube called a sigmoidoscope through your rectum and lower colon. The images are displayed on a video screen. Polyps are removed, if possible, and sent to a lab for testing.
Risk and Complications of Scope Exams
- Bleeding
- A puncture or tear in the colon
- Risks of anesthesia
- Failure to detect a polyp
When to Call Your Doctor After a Test
Call your doctor if you have any of the following after any screening test:
- Bleeding
- Fever over 101°F
- Severe Abdominal Pain
What Is a Colostomy?
During a colostomy part of the colon (large intestine) is removed or disconnected. If the large intestine was diseased, it may be removed. If it was injured, it may be disconnected for a short time while it heals, then reconnected. During a colostomy, the colon is brought through the abdominal wall. This makes an opening, called a stoma, for stool and mucus to pass out of the body.
Types of Colostomies
The type of colostomy you have depends on what part of the colon is removed or disconnected. The most common types of colostomies are:
Sigmoid Colostomy
- The last section of the colon is removed or disconnected. The rectum and anus may be removed, or they may be disconnected and left in the body.
- The stoma is usually on the lower left side of the abdomen.
- Stool is most often firm.
Descending Colostomy
- The sigmoid colon and part of the descending colon are removed or disconnected. The rectum and anus may be removed or just disconnected.
- The stoma is usually on the left side of the abdomen.
- Stool may be almost firm.
Transverse Colostomy
- All of the sigmoid and descending colon and part of the transverse colon are removed or disconnected. The rectum and anus may be removed or just disconnected.
- The stoma can be in the middle or on the right or left side of the upper abdomen.
- Stool varies from pastelike to almost liquid.
Types of Stomas
The stoma is created by bringing the colon through the abdominal wall and turning it back on itself, like a cuff. The stoma is pink and moist, like the inside of the mouth. It shrinks to its final size 6–8 weeks after surgery. The kind of stoma you have depends on your surgery. The most common types are:
 |
 |
 |
||
An end stoma, most often done for a permanent colostomy. Stool and mucus pass from the same opening. If the anus is not removed, mucus passes from it as well. |
A loop stoma, most often done for a temporary colostomy. Stool passes from one side of the stoma. Mucus passes from the other. The anus is most often not removed, so mucus passes from it, too. |
Two stomas may be done for a temporary or permanent colostomy. Stool passes from one stoma. Mucus passes from the other. If the anus is not removed, mucus passes from it as well. |
Types of Colon Resections
In colon resection, a portion of the colon is removed (resected) during surgery. The most common types of colorectal resection are listed below.
Right Hemicolectomy |
Left Hemicolectomy |
|
 |
 |
|
Part or all of the ascending colon and cecum are removed. The colon is then reconnected to the small intestine. |
Part or all of the descending colon is removed. The transverse colon is then reconnected to the rectum. |
|
Sigmoid Colectomy |
Low Anterior Resection |
|
 |
 |
|
Part or all of the sigmoid colon is removed. The descending colon is then reconnected to the rectum. |
The sigmoid colon and a portion of the rectum are removed. The descending colon is reconnected to the remaining rectum. |
|
Abdominal Perineal Resection |
||
 |
||
Part or all of the sigmoid colon and the entire rectum and anus are removed. A colostomy is then performed. |
Colostomy
After certain types of surgery, the colon and rectum may need to be kept clear of stool while they heal. In other cases, the rectum has been removed or can’t be reconnected to the rest of the colon. In either case, a colostomy is needed. This creates a new opening in the abdomen so waste can leave the body. You may need the new opening for a short time, or permanently. If you had a colostomy during colorectal surgery, your healthcare providers will help you learn how to care for it.
Having Laparoscopic Colon Surgery
After discussing your colon problem, you and your doctor may decide that laparoscopic treatment is right for you. How well you prepare can affect the success of surgery. Make sure you understand all instructions your doctor gives you. If you’re unclear about what to do, be sure to ask. To help prepare your body, you will be instructed on what to do before surgery. Follow these instructions carefully. Ask questions if something is unclear.
Preparing a Few Weeks Before Surgery
- Have a medical checkup. Have a thorough physical exam before surgery, as instructed by your doctor. This checks the health of your heart and lungs.
- Ask about medications. Tell your surgeon about all medications you take, and ask whether you should stop taking any of them. This includes prescription medications, aspirin, ibuprofen, and other over-the-counter drugs. Also, be sure to mention any herbs or supplements you take.
- Quit smoking. If you smoke, do your best to quit now. Smoking increases your risks during surgery and slows healing.
Preparing the Day Before Surgery
- Have only clear liquids. You will be told not to eat any solid foods and to drink only clear liquids on the day before surgery. These liquids include broth, plain tea, gelatin, and clear fruit juice. Any liquid that you can see through when it’s held up to the light is considered clear.
- Do your bowel prep. To be sure your colon is clear of stool, you’ll do a bowel prep the day before surgery. This involves drinking a liquid laxative, taking pills, using enemas, or using a combination of these methods. Ask your surgeon how many hours before surgery the bowel prep must be completed.
- Make sure your stomach is empty. Do not have anything to eat or drink, including water and chewing gum, after midnight the night before surgery. If you take any medication on a regular basis, ask your surgeon if you should take it during this time. If so, take the pills with small sips of water.
The Day of Surgery
When you arrive at the hospital, you will be asked fill out certain forms. You will then change into a gown. An IV (intravenous) line will be inserted into your arm. This provides fluids and medications. You’ll meet with your anesthesiologist or nurse anesthetist to discuss the medication that helps you sleep during surgery. Ask any questions you have at this time. Before surgery begins, you’ll be given general anesthesia to put you into a deep sleep. A soft tube called a catheter may be placed into your bladder to drain urine.
If Open Surgery Is Needed
Possible incision sites
During the procedure, the surgeon may find that it is safer to convert to open surgery. In most cases, this is because of a detail of anatomy that could not be seen on scans done before the surgery. It doesn’t mean that anything went wrong. Conversion to open surgery is done to assure the best outcome for you. Before surgery you’ll be asked to sign a release giving your consent for open surgery if it is needed.
During Your Surgery
- Your doctor makes several small incisions.
- A laparoscope (a thin telescope-like tube) is then placed into one of the small incisions. This allows your doctor to view the colon on a video monitor.
- The surgical tools are placed into the other incisions. (A larger incision may be made later to remove a part of the colon.)
- The problem part of the colon is resected (removed). Sometimes the two ends of the colon are joined. This is called an anastomosis.
- Once surgery is done, you’ll be taken to a recovery room.
Possible benefits of a laparoscopic approach:
- Less scarring
- Less pain
- Faster recovery
- Shorter hospital stay
- Quicker return to normal activity
Types of Colon Resection
The idea of having part of your colon removed may sound scary. But part or all of the colon can be resected (removed) without causing serious problems. After the section of bowel is removed, the two ends are then reconnected (anastomosis). Below are some of the surgeries that can be performed on the colon. The type of surgery depends on the location of the colon problem.
|
|
|
Right Hemicolectomy: Part or all of the ascending (right side) colon is removed. The remaining colon is then reconnected to the small intestine. |
Left Hemicolectomy: Part or all of the descending (left side) colon is removed. The remaining colon is then reconnected to the rectum. |
|
|
 |
|
Sigmoid Colectomy (Sigmoidectomy): Part or all of the sigmoid colon is removed. The descending colon is then reconnected to the rectum. |
Segmental Resection: One or more short segments of colon are removed. The remaining ends of the colon are reconnected. |
Risks and Complications
Risks and possible complications of colon surgery include the following:
- Infection
- Injury to nearby organs
- Anastomosis that leaks or separates
- Blood clots
- Bleeding
- Risks of anesthesia
- Temporary ileus (bowel muscles slow or stop, and gas and waste don’t move through the body)
Discharge Instructions for Colostomy
You just underwent a colostomy. This procedure involves removing or disconnecting part of the colon (large intestine). If your large intestine was diseased, it may have been removed. If it was injured, it may have been disconnected for a short time so that it can heal. After it heals, it will be reconnected. During a colostomy, the colon is rerouted through the abdominal wall. Stool and mucus can then pass out of the body through this opening, called a stoma. The following are general guidelines for home care following a colostomy. Your doctor and nurse will go over any information that is specific to your condition.
Home Care
- Take care of your stoma as directed. Your doctor and nurse discussed how to do this with you before you left the hospital.
- Ask your doctor or nurse for a patient education sheet about colostomy care before you leave the hospital. This will help remind you how to care for yourself.
- Don’t lift anything heavier than 5 pounds or push a vacuum cleaner until your doctor says it is okay.
- Don’t drive until after your first doctor’s appointment after your surgery.
- If you ride in a car for more than short trips, stop frequently to stretch your legs.
- Ask your doctor when you can expect to return to work. Most patients are able to return to work within 4–6 weeks after surgery.
- Increase your activity gradually. Take short walks on a level surface.
- Shower as needed. Ask a friend or family member to stand close by in case you need help.
- Wash your incision site with soap and water and pat it dry.
- Check your incision every day for redness, drainage, swelling, or separation of the skin.
- Take your medications exactly as directed. Don’t skip doses.
- Don’t take any over-the-counter medication unless your doctor tells you to do so.
Call your doctor immediately if you have any of the following:
- Excessive bleeding from your stoma
- Blood in your stool
- Stool that is very hard
- No gas or stool
- Change in the color of your stoma
- Bulging skin around your stoma
- A stoma that looks like it’s getting longer
- Fever of 100.4°F or higher, or chills
- Redness, swelling, bleeding, or drainage from your incision
- Constipation
- Diarrhea
- Nausea or vomiting
- Increased pain
Follow-Up
Make a follow-up appointment as directed by calling (717) 718-7707, if you have not done this previously.
Incision Care: Abdomen
Dressing your incision helps keep it clean, dry, and infection-free. That way it will heal faster. Follow the steps below.
1. Wash Your Hands and Set Up
- Use liquid soap. Lather for 1–2 minutes. Scrub between your fingers and under your nails.
- Rinse with warm water, keeping fingers pointing down. Use a clean paper towel to dry your hands and turn off the faucet.
- Put all your supplies on a clean cloth or paper towel. Open a plastic trash bag.
- Peel back the edges of the dressing packages. Pour any irrigation solutions into solution cups.
- Clean the scissors with soap and water. Cut each piece of tape 4 inches longer than the dressing.
2. Remove the Old Dressing
- Put on disposable gloves.
- Loosen the tape by pulling gently toward the incision. Remove the dressing one layer at a time. Put it right into the plastic bag.
- Remove your gloves and put them in the plastic bag. Wash your hands. Then put on new gloves.
3. Clean and Dress the Incision
- Clean the incision and apply a new dressing as directed.
- Put all used supplies in the plastic bag. Remove your gloves last and put them in the bag. Seal the bag and put it in the trash. Be sure to wash your hands again.
Call Your Doctor If You Have:
- Bleeding from the incision, or an increase in its size.
- Increased redness, swelling, or drainage.
- Pain in or around the incision.
- Change in the color of the incision.
- Fever over 101.0°F, or chills.