End of colon: The Colon: What it is, What it Does
Colostomy | Johns Hopkins Medicine
A colostomy is an operation that creates an opening for the colon, or large intestine, through the abdomen. A colostomy may be temporary or permanent. It is usually done after bowel surgery or injury. Most permanent colostomies are “end colostomies,” while many temporary colostomies bring the side of the colon up to an opening in the abdomen.
During an end colostomy, the end of the colon is brought through the abdominal wall, where it may be turned under, like a cuff. The edges of the colon are then stitched to the skin of the abdominal wall to form an opening called a stoma. Stool drains from the stoma into a bag or pouch attached to the abdomen. In a temporary “loop colostomy,” a hole is cut in the side of the colon and stitched to a corresponding hole in the abdominal wall. This can be more easily reversed later by simply detaching the colon from the abdominal wall and closing the holes to reestablish the flow of stool through the colon.
Reasons for the procedure
Colostomy surgery may be needed to treat several different diseases and conditions. These include:
Birth defect, such as a blocked or missing anal opening, called an imperforate anus
Serious infection, such as diverticulitis, inflammation of little sacs on the colon
Inflammatory bowel disease
Injury to the colon or rectum
Partial or complete intestinal or bowel blockage
Rectal or colon cancer
Wounds or fistulas in the perineum. A fistula is an abnormal connection between internal parts of the body, or between an internal organ and the skin. A woman’s perineum is the area between her anus and vulva; a man’s lies between his anus and scrotum.
The reason for the colostomy helps the healthcare provider decide whether it will be short-term or permanent. For example, some infections or injuries require giving the bowel a temporary rest, then reattaching it. A permanent colostomy may be required for a more serious or incurable problem, such as cancer that requires removal of the rectum, or a failure of the muscles that control elimination.
How the digestive system works
A colostomy won’t change the way your digestive system works. Normally, after you chew and swallow your food, it goes through your esophagus, or swallowing tube, into your stomach.
From there, it travels to your small intestine and then to your large intestine, or colon. Hours or days later, the indigestible residue leaves the storage area of your rectum via your anus, as stool. Stool typically stays loose and liquid during its passage through the upper colon. There, water is absorbed from it, so the stool gets firmer as it nears the rectum.
The ascending colon goes up the right side of your body. The stool here is liquid and somewhat acidic, and it contains digestive enzymes. The transverse colon goes across your upper abdomen, and the descending and sigmoid colon go down the left side of your body to your rectum. In the left colon, the stool becomes progressively less liquid, less acidic, and contains fewer enzymes.
Where your colon is interrupted determines how irritating to the skin your stool output will be. The more liquid the stool, the more important it will be to protect your abdominal skin after a colostomy.
Risks of the procedure
Getting a colostomy marks a big change in your life, but the surgery itself is uncomplicated. It will be performed under general anesthesia, so you will be unconscious and feel no pain. A colostomy may be done as open surgery, or laparoscopically, via several tiny cuts.
As with any surgery, the main risks for anesthesia are breathing problems and poor reactions to medications. A colostomy carries other surgical risks:
Damage to nearby organs
After surgery, risks include:
Narrowing of the colostomy opening
Scar tissue that causes intestinal blockage
Developing a hernia at the incision
Before the procedure
If possible, be sure to discuss your surgical and postsurgical options with a doctor and an ostomy nurse (a nurse who is specially trained to help colostomy patients) before surgery. It may also help to meet with an ostomy visitor. This is a volunteer who has had a colostomy and can help you understand how to live with one. And, before or after your surgery, you may wish to attend an ostomy support group. You can find out more about such groups from the United Ostomy Associations of America or the American Cancer Society.
During the procedure
Depending on why you need a colostomy, it will be made in one of 4 parts of the colon: ascending, transverse, descending, or sigmoid.
A transverse colostomy is performed on the middle section of the colon, and the stoma will be somewhere across the upper abdomen. This type of surgery–often temporary–is typically performed for diverticulitis, inflammatory bowel disease, cancer, blockage, injury or a birth defect. In a transverse colostomy, the stool leaves the colon through the stoma before reaching the descending colon. Your stoma may have one or two openings. One opening is for stool. The second possible stoma is for the mucus that the resting part of your colon normally keeps producing. If you have only one stoma, this mucus will pass through your rectum and anus.
An ascending colostomy goes on the right side of your abdomen, leaving only a short part of the colon active. It is generally performed only when blockage or severe disease prevents a colostomy further along the colon.
A descending colostomy goes on the lower left side of the abdomen, while a sigmoid colostomy–the most common type–is placed a few inches lower.
After the procedure
You may be able to suck on ice chips on the same day as your surgery. You’ll probably be given clear fluids the next day. Some people eat normally within two days after a colostomy.
A normal stoma is moist and pink or red colored. When you first see your colostomy, it may appear dark red and swollen, with bruises. Don’t worry. Within a few weeks, the color will lighten and bruises should disappear.
The bandage or clear pouch covering your colostomy right after surgery probably won’t be the same type that you’ll use at home. Your colostomy will drain stool from your colon into this colostomy pouch or bag. Your stool will probably be more liquid than before surgery. Your stool consistency will also depend on what type of colostomy you have and how much of your colon is still active.
In the hospital
A colostomy requires a hospital stay of about 3 days to a week. Your stay will probably be longer if the colostomy was performed for an emergency. During your hospital stay, you’ll learn to care for your colostomy and the appliance or pouch that collects your stool.
Your nurse will show you how to clean your stoma. After you go home, you’ll do this gently every day with warm water only. Then gently pat dry or allow the area to air dry. Don’t worry if you see a little bit of blood.
Use your time in the hospital to learn how to care for your colostomy. If you have an ascending or transverse colostomy, you will need to wear a slim, lightweight, drainable pouch at all times. There are many different types of pouches, varying in cost and made from odor-resistant materials.
Some people with a descending or sigmoid colostomy can eventually learn to predict when their bowels will move and wear a pouch only when they expect a movement. They may also be able to master a process called irrigation to stimulate regular, controlled bowel movements.
Before going home, be sure to talk with an ostomy nurse or other expert who can help you try out the equipment you’ll need. What works best will depend on what type of colostomy you have; the length of your stoma; your abdominal shape and firmness; any scars or folds near the stoma; and your height and weight.
Sometimes, the rectum and anus must be surgically removed, leaving what’s called a posterior wound. In the hospital, you’ll use dressings and pads to cover this wound, and you may also take sitz baths–shallow, warm-water soaks. Ask your doctor and nurse how to care for your posterior wound until it heals. If problems should occur, please contact your doctor.
The skin around your stoma should look the same as elsewhere on your abdomen. Exposure to stool, especially loose stool, can be irritating. Here are some tips to protect your skin:
Make sure your pouch and skin barrier opening are the right size.
Change the pouch regularly to avoid leakage and skin irritation. Don’t wait until your skin begins to itch and burn.
Remove the pouching system gently, pushing your skin away instead of pulling.
Barrier creams may be used if the skin becomes irritated despite these measures.
Notify your doctor to report any of the following:
Cramps that last more than two hours
Continuous nausea or throwing up
Bad or unusual odor for more than a week
Change in your stoma size or color
Blocked or bulging stoma
Bleeding from the stoma opening or in the pouch
Wound or cut in the stoma
Serious skin irritation or sores
Watery stool for more than five hours
Anything unusual that concerns you
A good rule is to empty your pouch when it’s one-third full. And be sure to change the pouch before it leaks. As a general rule, change it no more than once a day, but not less than every three or four days.
A colostomy represents a big change, but you will soon learn to live with it. Even though you can feel the pouch against your body, no one else can see it. Do not feel the need to explain your colostomy to everyone who asks; only share as much as you want to.
What Is Colorectal Cancer? | How Does Colorectal Cancer Start?
Colorectal cancer starts in the colon or the rectum. These cancers can also be called colon cancer or rectal cancer, depending on where they start. Colon cancer and rectal cancer are often grouped together because they have many features in common.
Cancer starts when cells in the body start to grow out of control. To learn more about how cancers start and spread, see What Is Cancer?
The colon and rectum
To understand colorectal cancer, it helps to know about the normal structure and function of the colon and rectum.
The colon and rectum make up the large intestine (or large bowel), which is part of the digestive system, also called the gastrointestinal (GI) system (see illustration below).
Most of the large intestine is made up of the colon, a muscular tube about 5 feet (1.5 meters) long. The parts of the colon are named by which way the food is traveling through them.
- The first section is called the ascending colon. It starts with a pouch called the cecum, where undigested food is comes in from the small intestine. It continues upward on the right side of the abdomen (belly).
- The second section is called the transverse colon. It goes across the body from the right to the left side.
- The third section is called the descending colon because it descends (travels down) on the left side.
- The fourth section is called the sigmoid colon because of its “S” shape. The sigmoid colon joins the rectum, which then connects to the anus.
The ascending and transverse sections together are called the proximal colon. The descending and sigmoid colon are called the distal colon.
How do the colon and rectum work?
The colon absorbs water and salt from the remaining food matter after it goes through the small intestine (small bowel). The waste matter that’s left after going through the colon goes into the rectum, the final 6 inches (15cm) of the digestive system. It’s stored there until it passes through the anus. Ring-shaped muscles (also called a sphincter) around the anus keep stool from coming out until they relax during a bowel movement.
How does colorectal cancer start?
Polyps in the colon or rectum
Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps.
Some types of polyps can change into cancer over time (usually many years), but not all polyps become cancer. The chance of a polyp turning into cancer depends on the type of polyp it is. There are different types of polyps.
- Adenomatous polyps (adenomas): These polyps sometimes change into cancer. Because of this, adenomas are called a pre-cancerous condition. The 3 types of adenomas are tubular, villous, and tubulovillous.
- Hyperplastic polyps and inflammatory polyps: These polyps are more common, but in general they are not pre-cancerous. Some people with large (more than 1cm) hyperplastic polyps might need colorectal cancer screening with colonoscopy more often.
- Sessile serrated polyps (SSP) and traditional serrated adenomas (TSA): These polyps are often treated like adenomas because they have a higher risk of colorectal cancer.
Other factors that can make a polyp more likely to contain cancer or increase someone’s risk of developing colorectal cancer include:
- If a polyp larger than 1 cm is found
- If more than 3 polyps are found
- If dysplasia is seen in the polyp after it’s removed. Dysplasia is another pre-cancerous condition. It means there’s an area in a polyp or in the lining of the colon or rectum where the cells look abnormal, but they haven’t become cancer.
For more details on the types of polyps and conditions that can lead to colorectal cancer, see Understanding Your Pathology Report: Colon Polyps.
How colorectal cancer spreads
If cancer forms in a polyp, it can grow into the wall of the colon or rectum over time. The wall of the colon and rectum is made up of many layers. Colorectal cancer starts in the innermost layer (the mucosa) and can grow outward through some or all of the other layers (see picture below).
When cancer cells are in the wall, they can then grow into blood vessels or lymph vessels (tiny channels that carry away waste and fluid). From there, they can travel to nearby lymph nodes or to distant parts of the body.
The stage (extent of spread) of a colorectal cancer depends on how deeply it grows into the wall and if it has spread outside the colon or rectum. For more on staging, see Colorectal Cancer Stages.
Most colorectal cancers are adenocarcinomas. These cancers start in cells that make mucus to lubricate the inside of the colon and rectum. When doctors talk about colorectal cancer, they’re almost always talking about this type. Some sub-types of adenocarcinoma, such as signet ring and mucinous, may have a worse prognosis (outlook) than other subtypes of adenocarcinoma.
Other, much less common types of tumors can also start in the colon and rectum. These include:
Colostomy | Cancer.Net
A colostomy is a surgery that makes a temporary or permanent opening called a stoma. A stoma is a path that goes from the large intestine to the outside of your abdomen. This helps solid waste and gas exit the body without passing through the rectum. The waste is collected in a pouch worn on the outside of your body.
What is the large intestine?
The large intestine is made up of the colon and rectum. It is connected to the small intestine. The small intestine digests nutrients and absorbs them into blood vessels. These nutrients include proteins, fats, and carbohydrates. Remaining food that cannot be digested moves from the small intestine to the colon. The colon absorbs water from the waste and stores the waste until the next bowel movement.
This illustration shows the 5 sections of the colon and rectum. The ascending colon is the beginning the large intestine into which the small intestine empties; it begins on the lower right side of the abdomen and then leads up to the transverse colon. The transverse colon crosses the top of the abdomen from right to left, leading to the descending colon, which takes waste down the left side. Finally, the sigmoid colon at the bottom takes waste a few more inches, down to the rectum. A cross-section of the rectum and sigmoid colon shows where waste leaves the body, through the anus. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.
Why do I need a colostomy?
A doctor may do a colostomy to bypass or remove part of the lower intestine. This may be because:
The large intestine is blocked or damaged
A part of the large intestine is surgically removed
A ruptured colon causes an abdominal infection
People with certain types of cancer, such as colorectal cancer, may need a colostomy. Sometimes people being treated for prostate, ovarian, uterine, or cervical cancer need a colostomy. People with Crohn’s disease, ulcerative colitis, or pre-cancerous colon polyps may also need an colostomy.
How long will I need a colostomy?
Most people who need a cancer-related colostomy only need it for a few months while the colon or rectum heals. But some people may need a permanent colostomy.
Types of colostomy
Each type is named for the section of the colon in which it is needed.
Sigmoid colostomy. This is the most common type. It is located in the bottom part of the large intestine. The sigmoid colon moves waste to the rectum. Sigmoid colostomies produce stool that is more solid and regular than other colostomies.
Transverse colostomy. The transverse colon crosses the top of the abdomen. Stool in this area is usually soft. This is because only a small portion of the colon has absorbed water from the indigestible material. This common type of colostomy has 3 versions:
A loop colostomy. This colostomy creates a stoma through which stool exits. In this type, the colon stays connected to the rectum. As a result, people will sometimes pass stool or gas through the rectum.
A single-barrel colostomy. This surgery removes the colon below the colostomy, including the rectum and anal opening. This type of colostomy is permanent.
A double-barrel colostomy. This divides the colon into 2 ends that form separate stomas. Stool exits from 1 of the stomas. Mucus made by the colon exits from the other. This type of transverse colostomy is the least common.
Descending colostomy. The descending colon takes waste down the left side of the abdomen. The stool there is usually firm because it has moved through the working parts of the colon.
Ascending colostomy. The ascending colon runs from the beginning of the large intestine to the right side of the abdomen. In this procedure, only part of the colon still works. As a result, little water is absorbed from the waste. This means the stool is usually liquid. This type of colostomy is rare. An ileostomy is more appropriate for this portion of the colon.
What should I expect during surgery?
You will receive general anesthesia before the surgery. During the surgery, the surgeon attaches 1 end of the colon to a stoma in a place where you can see and care for it. Then the surgeon attaches the colostomy bag to the stoma.
The procedure may be done with:
A surgical incision, which is a large cut in the abdomen
Laparoscopic surgery, which involves less invasive small cuts. This method reduces pain and recovery time.
Surgery may include the following risks:
How long will it take to recover from surgery?
Most people stay in the hospital for up to 1 week after the procedure. Complete recovery from a colostomy may take up to 2 months. During this time, you will have limits on what you can eat while the colon heals.
If the colostomy is temporary, you may need a reversal, or closure, surgery after the colon has healed. This surgery usually takes place about 3 months later.
Emptying your colostomy bag. Once you have recovered from surgery, you will need to empty the colostomy bag several times per day. You will not be able to control when stool and gas move into the pouch. It is best to empty it when the bag is less than half full.
Colostomy pouches come in many sizes and shapes, but there are 2 main types:
Other options include open-end or drainable and closed-end or disposable pouches. Ask your health care team about which type of colostomy pouch you will receive.
Caring for your skin. The skin surrounding the stoma is called peristomal skin. It will always look red and may bleed occasionally, which is normal. But bleeding should not continue for long.
It is important to make sure your pouch is correctly connected to your stoma. Pouches that do not fit well can irritate the skin. You should also keep this area clean and dry. If this skin appears wet, bumpy, itchy, or painful, contact your health care team. It is possible that the area may be infected.
High stool output. During the first few days after surgery, you may have a larger than normal stool output. As your body gets used to the stoma and colostomy, this amount will decrease. But if it does not decrease after a few days, call your health care team. Passing large amounts of stool means you may be losing too many fluids. This could lead to an imbalance in your electrolyte levels. Electrolytes are minerals that help regulate the body.
Managing gas. Just like with stool, you will also need to release gas from your colostomy pouch. The way you do this depends on the type of pouch. Some pouches have a filter that deodorizes and vents gas. This prevents the bag from becoming too stretched, coming off of the abdomen, or bursting.
Amounts of gas deposited into the pouch will vary based on the type of colostomy and your diet. Foods and drinks such as beans, onions, milk, and alcohol can cause excess gas. Swallowing air can also increase the amount of gas in your colon. This happens when you chew gum or drink through a straw. You may have a lot of gas right after surgery. But this should decrease as your body heals. Your health care team can provide information on food and lifestyle choices to help reduce gas.
Whole pills or capsules in stool. Coated pills and extended-release capsules may come out intact in your pouch. This can mean that the medication was not fully absorbed in your body. Tell your health care team if this happens. They may be able to prescribe liquid or gel medications for you to take instead.
Stoma obstruction. Sometimes your stoma may become blocked by a piece of undigested food and scar tissue. This means that stool and gas cannot pass into the pouch. An obstruction may cause abdominal pain or swelling or nausea and vomiting.
You may be able to remove the blockage at home. This can be done by avoiding solid foods and drinking more fluids, including warm drinks like tea. You can also try massaging your abdomen around the stoma or drawing your knees to your chest and rocking side to side. If these tips do not work, call your health care team right away.
Living With an Ostomy Bag
Life with an Ostomy Bag: 3 Tips for Thriving
Blocked Intestine or Gastrointestinal Obstruction
About Your Colon Resection Surgery
This guide will help you get ready for your colon resection surgery at Memorial Sloan Kettering (MSK). It will also help you understand what to expect during your recovery.
Use this guide as a source of information in the days leading up to your surgery. Bring it with you on the day of your surgery. You and your care team will refer to it as you learn more about your recovery.
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About Your Surgery
Your digestive system
Understanding how your digestive system works can be helpful as you get ready for and recover from your surgery.
Your digestive system is made up of organs that break down food, absorb nutrients, and remove waste from your body (see Figure 1). They include your:
- Esophagus (food pipe)
- Small intestine
- Colon (large intestine)
Figure 1. Your digestive system
After you chew and swallow your food, it moves into your esophagus. Your esophagus is a long, muscular tube that carries food from your mouth into your stomach. Once the food enters your stomach, it mixes with stomach acids. These acids start to digest (break down) the food.
When the food leaves your stomach, it moves into your small intestine. There it continues to be digested, and many nutrients are absorbed. Anything that isn’t absorbed is called waste.
The waste then moves into your colon, where some water is reabsorbed (taken back) into your body. The remaining waste enters the end of your colon, known as the rectum. Your rectum serves as a holding area for the waste until it leaves your body through your anus.
Colon resection is a surgery that’s done to treat colon cancer. The part of your colon with the cancer is removed. The healthy ends of your colon are then sewn back together. Your surgeon will explain which part of your colon will be removed (see Figure 2).
Figure 2. Parts of your colon
A colon resection can be done using different techniques. Your surgeon will talk with you about which options are right for you. Depending on what type of surgery you have, your surgeon will make 1 or more incisions (surgical cuts) in your abdomen (belly).
- When 1 long incision is made on your abdomen, this is called open surgery. The part of your colon that has the cancer is removed through the incision.
- When several small incisions are made on your abdomen, this is called minimally invasive surgery. Small surgical instruments and a video camera are put into the incisions to remove the part of your colon that has the cancer. Some surgeons use a robotic device to assist with the surgery.
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Before Your Surgery
The information in this section will help you get ready for your surgery. Read this section when your surgery is scheduled and refer to it as your surgery date gets closer. It has important information about what you need to do before your surgery.
As you read through this section, write down any questions you want to ask your healthcare provider.
Getting ready for your surgery
You and your care team will work together to get ready for your surgery.
Help us keep you safe during your surgery by telling us if any of the following statements apply to you, even if you aren’t sure.
- I take a blood thinner, such as:
- Warfarin (Jantoven® or Coumadin®)
- Clopidogrel (Plavix®)
- Enoxaparin (Lovenox®)
- Dabigatran (Pradaxa®)
- Apixaban (Eliquis®)
- Rivaroxaban (Xarelto®)
There are others, so be sure your healthcare provider knows all the medications you’re taking.
- I take prescription medications (medications my healthcare provider prescribes), including patches and creams.
- I take over-the-counter medications (medications I buy without a prescription), including patches and creams.
- I take dietary supplements, such as herbs, vitamins, minerals, or natural or home remedies.
- I have a pacemaker, automatic implantable cardioverter-defibrillator (AICD), or other heart device.
- I have sleep apnea.
- I’ve had a problem with anesthesia (medication to make me sleep during surgery) in the past.
- I’m allergic to certain medication(s) or materials, including latex.
- I’m not willing to receive a blood transfusion.
- I drink alcohol.
- I smoke or use an electronic smoking device (such as a vape pen, e-cigarette, or Juul®).
- I use recreational drugs.
About drinking alcohol
The amount of alcohol you drink can affect you during and after your surgery. It’s important to talk with your healthcare providers about how much alcohol you drink. This will help us plan your care.
- If you stop drinking alcohol suddenly, it can cause seizures, delirium, and death. If we know you’re at risk for these complications, we can prescribe medications to help keep them from happening.
- If you drink alcohol regularly, you may be at risk for other complications during and after your surgery. These include bleeding, infections, heart problems, and a longer hospital stay.
Here are things you can do before your surgery to keep from having problems:
- Be honest with your healthcare providers about how much alcohol you drink.
- Try to stop drinking alcohol once your surgery is planned. If you develop a headache, nausea (feeling like you’re going to throw up), increased anxiety, or can’t sleep after you stop drinking, tell your healthcare provider right away. These are early signs of alcohol withdrawal and can be treated.
- Tell your healthcare provider if you can’t stop drinking.
- Ask your healthcare provider questions about drinking and surgery. As always, all of your medical information will be kept confidential.
If you smoke, you can have breathing problems when you have surgery. Stopping even for a few days before surgery can help. Your healthcare provider will refer you to our Tobacco Treatment Program if you smoke. You can also reach the program by calling 212-610-0507.
About sleep apnea
Sleep apnea is a common breathing disorder that causes you to stop breathing for short periods of time while sleeping. The most common type is obstructive sleep apnea (OSA). With OSA, your airway becomes completely blocked during sleep. OSA can cause serious problems during and after surgery.
Please tell us if you have sleep apnea or if you think you might have it. If you use a breathing device (such as a CPAP device) for sleep apnea, bring it with you the day of your surgery.
MyMSK (my.mskcc.org) is your MSK patient portal account. You can use MyMSK to send and receive messages from your care team, view your test results, see your appointment dates and times, and more. You can also invite your caregiver to create their own account so they can see information about your care.
If you don’t have a MyMSK account, you can visit my.mskcc.org, call 646-227-2593, or call your doctor’s office for an enrollment ID to sign up. You can also watch our video How to Enroll in MyMSK: Memorial Sloan Kettering’s Patient Portal. For help, contact the MyMSK Help Desk by emailing [email protected] or calling 800-248-0593.
About your MyMSK Goals to Discharge Checklist
When your surgery is over, you’ll focus on getting well enough to leave the hospital. We’ll send a Goals to Discharge Checklist to your MyMSK account to help you track how you’re doing. You can use this electronic checklist to see the goals you need to meet before leaving the hospital and update your progress throughout the day. Your updates also send alerts to your surgical team about your progress.
For more information, read the resource How to Use Your MyMSK Goals to Discharge Checklist.
About Enhanced Recovery After Surgery (ERAS)
ERAS is a program to help you get better faster after your surgery. As part of the ERAS program, it’s important to do certain things before and after your surgery.
Before your surgery, make sure you’re ready by doing the following things:
- Read this guide. It will help you know what to expect before, during, and after your surgery. If you have questions, write them down. You can ask your healthcare provider at your next appointment, or you can call their office.
- Exercise and follow a healthy diet. This will help get your body ready for your surgery.
After your surgery, help yourself recover more quickly by doing the following things:
- Read your recovery pathway. This is a written educational resource that your healthcare provider will give you. It has goals for your recovery and will help you know what to do and expect on each day during your recovery.
- Start moving around as soon as you can. The sooner you’re able to get out of bed and walk, the quicker you’ll be able to get back to your normal activities.
Within 30 days of your surgery
Presurgical Testing (PST)
Before your surgery, you’ll have an appointment for presurgical testing (PST). The date, time, and location will be printed on the appointment reminder from your surgeon’s office. It’s helpful to bring the following things to your PST appointment:
- A list of all the medications you’re taking, including prescription and over-the-counter medications, patches, and creams.
- Results of any tests done outside of MSK, such as a cardiac stress test, echocardiogram, or carotid doppler study.
- The name(s) and telephone number(s) of your healthcare provider(s).
You can eat and take your usual medications the day of your appointment.
During your PST appointment, you’ll meet with a nurse practitioner (NP). They work closely with anesthesiology staff (specialized healthcare providers who will give you anesthesia during your surgery). Your NP will review your medical and surgical history with you. You may have tests, such as an electrocardiogram (EKG) to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care. Your NP may also recommend that you see other healthcare providers.
Your NP will talk with you about which medications you should take the morning of your surgery.
Identify your caregiver
Your caregiver plays an important role in your care. Before your surgery, you and your caregiver will learn about your surgery from your healthcare providers. After your surgery, your caregiver will take you home when you’re discharged from the hospital. They’ll also help you care for yourself at home.
Resources and support are available to help manage the responsibilities that come with caring for a person going through cancer treatment. For support resources and information, visit www.mskcc.org/caregivers or read A Guide for Caregivers.
Complete a Health Care Proxy form
If you haven’t already completed a Health Care Proxy form, we recommend you complete one now. If you’ve already completed one or have any other advance directives, bring them to your next appointment.
A health care proxy is a legal document that identifies the person who will speak for you if you can’t communicate for yourself. The person you identify is called your health care agent.
Talk with your healthcare provider if you’re interested in completing a health care proxy. You can also read the resources Advance Care Planning and How to Be a Health Care Agent for information about health care proxies, other advance directives, and being a health care agent.
7 days before your surgery
Follow your healthcare provider’s instructions for taking aspirin
If you take aspirin or a medication that contains aspirin, you may need to change your dose or stop taking it 7 days before your surgery. Aspirin can cause bleeding.
Follow your healthcare provider’s instructions. Don’t stop taking aspirin unless they tell you to. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements
Stop taking vitamin E, multivitamins, herbal remedies, and other dietary supplements 7 days before your surgery. These things can cause bleeding. For more information, read the resource Herbal Remedies and Cancer Treatment.
Buy bowel preparation supplies
You’ll need to do a bowel preparation (clear the stool from your body) before your surgery. Your healthcare provider will give you a prescription for antibiotics to take as part of your bowel preparation. You’ll also need to buy the following supplies:
- 1 (238-gram) bottle of polyethylene glycol (MiraLAX®). You can get this from your local pharmacy. You don’t need a prescription.
- 1 (64-ounce) bottle of a clear liquid. For examples of clear liquids, read the “Follow a clear liquid diet” section.
- Extra clear liquids to drink while you’re following a clear liquid diet.
2 days before your surgery
Stop taking nonsteroidal anti-inflammatory drugs (NSAIDs)
Stop taking NSAIDs, such as ibuprofen (Advil® and Motrin®) and naproxen (Aleve®), 2 days before your surgery. These medications can cause bleeding. For more information, read the resource Common Medications Containing Aspirin, Other Nonsteroidal Anti-inflammatory Drugs (NSAIDs), or Vitamin E.
Don’t shave or wax your abdominal area starting 2 days before your surgery. This will lower your risk of getting an infection.
1 day before your surgery
Follow a clear liquid diet
You’ll need to follow a clear liquid diet the day before your surgery. A clear liquid diet includes only liquids you can see through. You can find examples in the “Clear liquid diet” table.
While you’re following a clear liquid diet:
- Don’t eat any solid foods.
- Try to drink at least 1 (8-ounce) glass of clear liquid every hour while you’re awake.
- Drink different types of clear liquids. Don’t just drink water, coffee, and tea.
- Don’t drink sugar-free liquids unless you have diabetes and a member of your care team tells you to.
For people with diabetes
If you have diabetes, ask the healthcare provider who manages your diabetes what to do while you’re following a clear liquid diet.
- If you take insulin or another medication for diabetes, ask if you need to change the dose.
- Ask if you should drink sugar-free clear liquids.
Make sure to check your blood sugar level often while you’re following a clear liquid diet. If you have any questions, talk with your healthcare provider.
|Clear liquid diet|
|Drink||Do Not Drink|
Start your bowel preparation
Start your bowel preparation 1 day before your surgery.
On the morning of the day before your surgery, mix all 238 grams of MiraLAX with the 64 ounces of clear liquid until the MiraLAX powder dissolves. Once the MiraLAX is dissolved, you can put the mixture in the refrigerator, if you prefer.
At 5:00 pm on the day before your surgery, start drinking the MiraLAX mixture. The MiraLAX will cause frequent bowel movements, so make sure you’re near a bathroom.
- Drink 1 (8-ounce) glass of the mixture every 15 minutes until the container is empty.
- When you finish the MiraLAX mixture, drink 4 to 6 glasses of clear liquids.
- Apply zinc oxide ointment or Desitin® to the skin around your anus after every bowel movement. This helps prevent irritation.
At 7:00 pm on the day before your surgery, take your antibiotics as instructed.
At 10:00 pm on the day before your surgery, take your antibiotics as instructed.
You can keep drinking clear liquids until midnight, but you don’t have to.
Note the time of your surgery
A staff member from the Admitting Office will call you after 2:00 pm the day before your surgery. If your surgery is scheduled for a Monday, they’ll call you on the Friday before. If you don’t get a call by 7:00 pm, call 212-639-5014.
The staff member will tell you what time to arrive at the hospital for your surgery. They’ll also remind you where to go.
Shower with a 4% chlorhexidine gluconate (CHG) solution antiseptic skin cleanser (such as Hibiclens®)
4% CHG solution is a skin cleanser that kills germs for 24 hours after you use it. Showering with it before your surgery will help lower your risk of infection after surgery. Your nurse will give you a bottle to use before your surgery.
The night before your surgery, shower using a 4% CHG solution antiseptic skin cleanser.
- Use your normal shampoo to wash your hair. Rinse your head well.
- Use your normal soap to wash your face and genital area. Rinse your body well with warm water.
- Open the 4% CHG solution bottle. Pour some into your hand or a clean washcloth.
- Move away from the shower stream. Rub the 4% CHG solution gently over your body from your neck to your feet. Don’t put it on your face or genital area.
- Move back into the shower stream to rinse off the 4% CHG solution. Use warm water.
- Dry yourself off with a clean towel after your shower.
- Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Instructions for eating before your surgery
Do not eat anything after midnight the night before your surgery. This includes hard candy and gum.
The morning of your surgery
Instructions for drinking before your surgery
- If your healthcare provider gave you a CF(Preop)® drink, finish it 2 hours before your scheduled arrival time. Do not drink anything else after midnight the night before your surgery, including water.
- If your healthcare provider didn’t give you a CF(Preop) drink, you can drink a total of 12 ounces of water between midnight and 2 hours before your scheduled arrival time. Do not drink anything else.
Do not drink anything starting 2 hours before your scheduled arrival time. This includes water.
Take your medications as instructed
If your healthcare provider told you to take certain medications the morning of your surgery, take only those medications with a sip of water. Depending on what medications you take, this may be all, some, or none of your usual morning medications.
Shower with a 4% CHG solution antiseptic skin cleanser (such as Hibiclens)
Shower with a 4% CHG solution antiseptic skin cleanser before you leave for the hospital. Use it the same way you did the night before.
Don’t put on any lotion, cream, deodorant, makeup, powder, perfume, or cologne after your shower.
Things to remember
- Wear something comfortable and loose-fitting.
- If you wear contact lenses, wear your glasses instead. Wearing contact lenses during surgery can damage your eyes.
- Don’t wear any metal objects. Remove all jewelry, including body piercings. The equipment used during your surgery can cause burns if it touches metal.
- Leave valuable items at home.
- If you’re menstruating (have your monthly period), use a sanitary pad, not a tampon. You’ll get disposable underwear, as well as a pad if needed.
What to bring
- A pair of loose-fitting pants (such as sweatpants).
- Sneakers that lace up. You may have some swelling in your feet. Lace-up sneakers can fit over this swelling.
- Your breathing device for sleep apnea (such as your CPAP machine), if you have one.
- Your Health Care Proxy form and other advance directives, if you completed them.
- Your cell phone and charger.
- Only the money you may want for small purchases (such as a newspaper).
- A case for your personal items (such as eyeglasses, hearing aid(s), dentures, prosthetic device(s), wig, and religious articles), if you have one.
- This guide. You’ll use it when you learn how to care for yourself after surgery.
Where to park
MSK’s parking garage is located on East 66th Street between York and First Avenues. If you have questions about prices, call 212-639-2338.
To reach the garage, turn onto East 66th Street from York Avenue. The garage is located about a quarter of a block in from York Avenue, on the right-hand (north) side of the street. There’s a tunnel that you can walk through that connects the garage to the hospital.
There are also other garages located on East 69th Street between First and Second Avenues, East 67th Street between York and First Avenues, and East 65th Street between First and Second Avenues.
Once you’re in the hospital
When you get to the hospital, take the B elevator to the 6th floor and check in at the desk in the PSC waiting room.
You’ll be asked to say and spell your name and birth date many times. This is for your safety. People with the same or a similar name may be having surgery on the same day.
When it’s time to change for surgery, you’ll get a hospital gown, robe, and nonskid socks to wear.
Meet with a nurse
You’ll meet with a nurse before surgery. Tell them the dose of any medications you took after midnight (including prescription and over-the-counter medications, patches, and creams) and the time you took them.
Your nurse may place an intravenous (IV) line in one of your veins, usually in your arm or hand. If your nurse doesn’t place the IV, your anesthesiologist will do it in the operating room.
Meet with an anesthesiologist
You’ll also meet with an anesthesiologist before surgery. They will:
- Review your medical history with you.
- Ask you if you’ve had any problems with anesthesia in the past, including nausea or pain.
- Talk with you about your comfort and safety during your surgery.
- Talk with you about the kind of anesthesia you’ll get.
- Answer your questions about your anesthesia.
Get ready for your surgery
When it’s time for your surgery, you’ll need to remove your hearing aids, dentures, prosthetic devices, wig, and religious articles, if you have them.
You’ll either walk into the operating room or a staff member will bring you there a stretcher. A member of the operating room team will help you onto the operating bed and place compression boots on your lower legs. These gently inflate and deflate to help blood flow in your legs.
Once you’re comfortable, your anesthesiologist will give you anesthesia through your IV line and you’ll fall asleep. You’ll also get fluids through your IV line during and after your surgery.
During your surgery
After you’re fully asleep, your care team will place a breathing tube through your mouth into your windpipe to help you breathe. They’ll also place a urinary (Foley) catheter in your bladder to drain your urine (pee) during your surgery.
Once your surgery is finished, your surgeon will close your incision with sutures (stitches), staples, Dermabond® (surgical glue), or Steri-Strips™ (thin pieces of surgical tape). They may also cover them with a bandage.
Your breathing tube is usually taken out while you’re still in the operating room.
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After Your Surgery
The information in this section will tell you what to expect after your surgery, both during your hospital stay and after you leave the hospital. You’ll learn how to safely recover from your surgery.
As you read through this section, write down any questions you want to ask your healthcare provider.
In the Post-Anesthesia Care Unit (PACU)
When you wake up after your surgery, you’ll be in the PACU. A nurse will be keeping track of your body temperature, pulse, blood pressure, and oxygen levels. You may be getting oxygen through a thin tube that rests below your nose or a mask that covers your nose and mouth. You’ll also have compression boots on your lower legs.
You’ll get medication to control your pain and keep you comfortable. There are different ways pain medication can be given:
- Epidural catheter: Some people get pain medication through an epidural catheter (thin, flexible tube in their spine).
- Nerve block: Some people get a nerve block before or during surgery. With a nerve block, your healthcare provider injects medication into some of your nerves to reduce pain after surgery.
- IV medications: Some people get pain medication into a vein through their IV line.
You’ll have 1 or more of these after your surgery. They’re all effective ways to control your pain. Your healthcare provider will talk with you before choosing the best one(s) for you.
Tubes and drains
You’ll have a Foley catheter in your urethra going into your bladder. This tube drains urine from your bladder so your care team can keep track of how much urine you’re making.
You may also have 1 or 2 Jackson-Pratt (JP) drains to remove extra fluid from your abdomen (belly). Your healthcare providers will talk with you about what to expect.
Moving to your hospital room
You’ll stay in the PACU until you’re awake and your pain is under control. Most people move to their hospital room after a few hours in the PACU, but some people stay in the PACU overnight for observation.
After your stay in the PACU, a staff member will take you to your hospital room.
In your hospital room
The length of time you’re in the hospital after your surgery depends on your recovery and the exact surgery you had. Most people stay in the hospital for 2 to 4 days. Your care team will tell you what to expect.
When you’re taken to your hospital room, you’ll meet one of the nurses who will care for you while you’re in the hospital. Soon after you arrive in your room, your nurse will help you out of bed and into your chair.
While you’re in the hospital, your nurses will teach you how to care for yourself while you’re recovering from your surgery. You can help yourself recover more quickly by doing the following things:
- Read your recovery pathway. Your healthcare provider will give you a pathway with goals for your recovery, if you don’t already have one. It will help you know what to do and expect on each day during your recovery.
- Start moving around as soon as you can. The sooner you get out of bed and walk, the quicker you can get back to your normal activities.
You can use your MyMSK Goals to Discharge Checklist to track your progress during your recovery. For more information, read the resource How to Use Your MyMSK Goals to Discharge Checklist.
Read the resource Call! Don’t Fall! to learn about what you can do to stay safe and keep from falling while you’re in the hospital.
Managing your pain
You’ll have some pain after your surgery. At first, you’ll get your pain medication through an epidural catheter, nerve block, or IV line.
Your healthcare providers will ask you about your pain often and give you medication as needed. If your pain isn’t relieved, tell one of your healthcare providers. It’s important to control your pain so you can cough, breathe deeply, use your incentive spirometer, and move around. Controlling your pain will help you recover better.
Many people find their pain is controlled with over-the-counter medications alone. If you need stronger pain medication in the hospital, one of your healthcare providers will give you a prescription before you leave. Talk with your healthcare providers about possible side effects and how to taper (slowly stop taking) your medication.
Moving around and walking
Moving around and walking will help lower your risk for blood clots and pneumonia (lung infection). It will also help you start passing gas and having bowel movements (pooping) again.
Read your recovery pathway to learn about your specific moving and walking goals. Your nurse, physical therapist, or occupational therapist will help you move around, if needed.
Exercising your lungs
It’s important to exercise your lungs so they expand fully. This helps prevent pneumonia.
- Your nurse will give you an incentive spirometer. Use it 10 times every hour you’re awake. For more information, read the resource How to Use Your Incentive Spirometer.
- Do coughing and deep breathing exercises. A member of your care team will teach you how to do them.
Eating and drinking
You’ll slowly go back to eating solid foods starting the day after your surgery. Read your pathway and talk with your care team for more information. If you have questions about your diet, ask to see a clinical dietitian nutritionist.
A member of your care team will help you shower while you’re in the hospital. This will help keep your incision clean and prevent infections.
Leaving the hospital
By the time you’re ready to leave the hospital, your incisions will have started to heal. Before you leave, look at your incisions with one of your healthcare providers. Knowing what they look like will help you notice any changes later.
On the day of your discharge, plan to leave the hospital between 8:00 am and 10:00 am. Before you leave, one of your healthcare providers will write your discharge order and prescriptions. You’ll also get written discharge instructions. One of your healthcare providers will review them with you before you leave.
If your ride isn’t at the hospital when you’re ready to be discharged, you may be able to wait in the Patient Transition Lounge. A member of your care team will give you more information.
Read the resource What You Can Do to Avoid Falling to learn what you can do to stay safe and keep from falling at home and during your appointments at MSK.
Filling out your Recovery Tracker
We want to know how you’re feeling after you leave the hospital. To help us continue caring for you, we’ll send questions to your MyMSK account every day for 10 days after you leave the hospital. These questions are known as your Recovery Tracker.
Fill out your Recovery Tracker every day before midnight (12:00 am). It only takes 2 to 3 minutes to complete. Your answers to these questions will help us understand how you’re feeling and what you need.
Based on your answers, we may reach out to you for more information or ask you to call your surgeon’s office. You can always contact your surgeon’s office if you have any questions. For more information, read the resource About Your Recovery Tracker .
Managing your pain
People have pain or discomfort for different lengths of time. You may still have some pain when you go home and will probably be taking pain medication. Some people have soreness, tightness, or muscle aches around their incisions as they recover. This doesn’t mean that something is wrong. If it doesn’t get better, contact your healthcare provider.
Follow the guidelines below to help manage your pain at home.
- Take your medications as directed and as needed.
- Call your healthcare provider if the medication prescribed for you doesn’t ease your pain.
- Don’t drive or drink alcohol while you’re taking prescription pain medication. Some prescription pain medications can make you drowsy. Alcohol can make the drowsiness worse.
- As your incision heals, you’ll have less pain and need less pain medication. An over-the-counter pain reliever such as acetaminophen (Tylenol®) or ibuprofen (Advil® or Motrin®) will ease aches and discomfort.
- Follow your healthcare provider’s instructions for stopping your prescription pain medication.
- Don’t take more of any medication than the amount directed on the label or as instructed by your healthcare provider.
- Read the labels on all the medications you’re taking, especially if you’re taking acetaminophen. Acetaminophen is an ingredient in many over-the-counter and prescription medications. Taking too much can harm your liver. Don’t take more than one medication that contains acetaminophen without talking with a member of your care team.
- Pain medication should help you resume your normal activities. Take enough medication to do your activities and exercises comfortably. It’s normal for your pain to increase a little as you start to be more active.
- Keep track of when you take your pain medication. It works best 30 to 45 minutes after you take it. Taking it when you first have pain is better than waiting for the pain to get worse.
Some prescription pain medications (such as opioids) may cause constipation (having fewer bowel movements than usual).
Talk with your healthcare provider about how to manage constipation. You can also follow the guidelines below.
- Go to the bathroom at the same time every day. Your body will get used to going at that time. If you feel like you need to go, though, don’t put it off.
- Try to use the bathroom 5 to 15 minutes after meals. After breakfast is a good time to go. That’s when the reflexes in your colon are strongest.
- Exercise, if you can. Walking is an excellent form of exercise.
- Drink 8 to 10 (8-ounce) glasses (2 liters) of liquids daily, if you can. Drink water and other liquids, including juices (such as prune juice) and soups.
- Both over-the-counter and prescription medications are available to treat constipation. Talk with your healthcare provider about which one is best for you.
If you have questions about constipation, contact your healthcare provider.
Managing other changes in bowel function
When part of your colon is removed, the part that’s left adapts to the change. Your colon will start to adapt shortly after your surgery. During this time, you may have gas, cramps, or changes in your bowel habits (such as diarrhea or frequent bowel movements). These changes may take weeks or months to go away.
If you’re having problems with changes in your bowel function, talk with your healthcare providers. You can also try the tips below.
Tips for managing gas
If you have gas or feel boated, avoid foods that can cause gas. Examples include beans, broccoli, onions, cabbage, and cauliflower.
Tips for managing diarrhea
If you have diarrhea, it’s important to drink at least 8 to 10 (8-ounce) glasses of liquids every day. Drink water and drinks with salt, such as broth and sports drinks (such as Gatorade). This will help you keep from becoming dehydrated and feeling weak.
Following the BRAT diet can also help control diarrhea. The BRAT diet is made up mostly of:
- Bananas (B)
- White rice (R)
- Applesauce (A)
- Toast (T)
If you’re having diarrhea more than 4 to 5 times a day, or if it smells worse than normal, call your healthcare provider.
Tips for managing soreness
If you have soreness around your anus from frequent bowel movements:
- Soak in warm water 2 to 3 times a day.
- Apply zinc oxide ointment (such as Desitin®) to the skin around your anus after every bowel movement. This helps prevent irritation.
- Don’t use harsh toilet tissue. You can use a nonalcohol wipe (such as a moistened flushable wipe) instead.
- If your healthcare provider prescribes medication, take it as directed.
Caring for your incisions
It’s normal for the skin below your incisions to feel numb. This happens because some of your nerves were cut during your surgery, even if you had a nerve-sparing procedure. The numbness will go away over time.
Change your bandages at least once a day, or more often if they become wet. Check your incisions every day for any signs of infection until your healthcare provider tells you they’re healed. Call your healthcare provider if you develop any of the following signs of an infection:
- Increased pain
- Warmth at the incision site
- Foul-smelling or pus-like drainage from your incision
- A fever of 100.5 °F (38 °C) or higher
To keep from getting an infection, don’t let anyone touch your incisions. Clean your hands with soap and water or an alcohol-based hand sanitizer before you touch your incisions.
If you go home with staples or sutures in your incisions, your healthcare provider will take them out during one of your appointments after surgery. It’s OK to get them wet. If you go home with Steri-Strips or Dermabond on your incisions, they’ll loosen and peel off by themselves. If they haven’t come off after about 14 days, you can take them off.
Shower every day. Taking a warm shower is relaxing and can help ease muscle aches. You’ll also clean your incision when you shower.
Take your bandages off before you shower. When you shower, gently wash your incisions with a fragrance-free, liquid soap. Don’t scrub your incisions or use a washcloth on them. This could irritate them and keep them from healing.
When you’re finished with your shower, gently pat your incisions with a clean towel. Let them air dry completely before getting dressed. If there’s no drainage, leave your incisions uncovered.
Don’t take tub baths or go swimming until your healthcare provider says it’s OK.
Eating and drinking
Parts of your colon can be removed without having a major impact on your nutritional health. While the part of your colon that’s left is adjusting, drink 8 to 10 (8-ounce) glasses of liquids every day and make sure you’re getting enough nutrients.
Your healthcare provider will give you dietary guidelines to follow after your surgery. If you need to reach a clinical dietitian nutritionist after you go home, call 212-639-7312.
Physical activity and exercise
When you leave the hospital, your incisions may look like they’re healed on the outside, but they won’t be healed on the inside. For the first 6 weeks after your surgery:
- Don’t lift, push, or pull anything heavier than 10 pounds (about 4.5 kilograms).
- Don’t do any strenuous activities (such as jogging and tennis).
- Don’t play any contact sports (such as football).
Walking is a good way to increase your endurance. You can walk outside or indoors at your local mall or shopping center. You can also climb stairs, but try to limit how often you do this for the first week you’re home. Don’t go out by yourself until you’re sure of what you can do.
It’s normal to have less energy than usual after your surgery. Recovery time is different for everyone. Increase your activities each day as much as you can. Always balance activity periods with rest periods. If you can’t sleep at night, it may be a sign that you’re resting too much during the day.
Driving may cause discomfort while you’re healing because you use your abdominal muscles (abs) when you brake. Ask your healthcare provider when you can drive. Don’t drive while you’re taking pain medication that may make you drowsy. You can ride in a car as a passenger at any time after you leave the hospital.
Your healthcare provider will tell you when you can start having sexual activity.
Going back to work
Talk with your healthcare provider about your job and when it may be safe for you to start working again. If your job involves lots of movement or heavy lifting, you may need to stay out a little longer than if you sit at a desk.
Getting your test results
After your surgery, the tumor and the tissue around it will be sent to a pathologist. Your test results will be ready about 7 business days after your surgery. Your surgeon will talk with you about the results and whether they recommend any additional treatments.
Your first appointment after your surgery will be 1 to 3 weeks after you’re discharged from the hospital. Call your surgeon’s office to schedule it.
It’s important to go to all your follow-up appointments after your surgery. You can call your healthcare provider if you have questions between these appointments.
Managing your feelings
After surgery for a serious illness, you may have new and upsetting feelings. Many people say they felt weepy, sad, worried, nervous, irritable, and angry at one time or another. You may find that you can’t control some of these feelings. If this happens, it’s a good idea to seek emotional support. Your healthcare provider can refer you to MSK’s Counseling Center. You can also reach them by calling 646-888-0200.
Whether you’re in the hospital or at home, we’re here to help you and your family and friends handle the emotional aspects of your illness.
When to contact your healthcare provider
Contact your healthcare provider if:
- You have a fever of 100.5 °F (38 °C) or higher.
- You have pain in your abdomen, nausea, and vomiting.
- You have any of the following signs of infection in your incision:
- Increased pain
- Warmth at the incision site
- Foul-smelling or pus-like drainage
- You have trouble urinating (peeing).
- You have pain at your incision that isn’t eased by pain medication.
- You’re bleeding from your rectum.
- You have any questions or concerns.
Monday through Friday from 9:00 am to 5:00 pm, contact your healthcare provider.
After 5:00 pm, during the weekend, and on holidays, call 212-639-2000 and ask to speak to the person on call for your healthcare provider.
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This section has a list of support services that may help you get ready for your surgery and recover safely.
As you read through this section, write down any questions you want to ask your healthcare provider.
MSK support services
Call if you have questions about your hospital admission, including requesting a private room.
Call if you have questions about anesthesia.
Blood Donor Room
Call for more information if you’re interested in donating blood or platelets.
Bobst International Center
MSK welcomes patients from around the world. If you’re an international patient, call for help arranging your care.
At MSK, our chaplains are available to listen, help support family members, pray, contact community clergy or faith groups, or simply be a comforting companion and a spiritual presence. Anyone can request spiritual support, regardless of formal religious affiliation. The interfaith chapel is located near the main lobby of Memorial Hospital and is open 24 hours a day. If you have an emergency, please call the hospital operator and ask for the chaplain on call.
Many people find that counseling helps them. We provide counseling for individuals, couples, families, and groups, as well as medications to help if you feel anxious or depressed. To make an appointment, ask your healthcare provider for a referral or call the number above.
Food Pantry Program
The food pantry program provides food to people in need during their cancer treatment. For more information, talk with your healthcare provider or call the number above.
Integrative Medicine Service
Integrative Medicine Service offers many services to complement (go along with) traditional medical care, including music therapy, mind/body therapies, dance and movement therapy, yoga, and touch therapy.
You can visit our library website or speak with the library reference staff to find more information about your specific cancer type. You can also visit LibGuides on MSK’s library website at libguides.mskcc.org.
Patient and Caregiver Education
Visit the Patient and Caregiver Education website to search our virtual library. There you can find written educational resources, videos, and online programs.
Patient and Caregiver Peer Support Program
You may find it comforting to speak with someone who has been through a treatment similar to yours. You can talk with a former MSK patient or caregiver through our Patient and Caregiver Peer Support Program. These conversations are confidential. They may take place in person or over the phone.
Call if you have questions about preauthorization with your insurance company. This is also called preapproval.
Patient Representative Office
Call if you have questions about the Health Care Proxy form or if you have concerns about your care.
Perioperative Nurse Liaison
Call if you have questions about MSK releasing any information while you’re having surgery.
Private Duty Nursing Office
You may request private nurses or companions. Call for more information.
Resources for Life After Cancer (RLAC) Program
At MSK, care doesn’t end after active treatment. The RLAC Program is for patients and their families who have finished treatment. This program has many services, including seminars, workshops, support groups, counseling on life after treatment, and help with insurance and employment issues.
Sexual Health Programs
Cancer and cancer treatments can have an impact on your sexual health. MSK’s Sexual Health Programs can help you take action and address sexual health issues before, during, or after your treatment.
- Our Female Sexual Medicine and Women’s Health Program can help if you’re dealing with cancer-related sexual health challenges such as premature menopause or fertility issues. For more information or to make an appointment, call 646-888-5076.
- Our Male Sexual and Reproductive Medicine Program can help if you’re dealing with cancer-related sexual health challenges such as erectile dysfunction (ED). For more information or to make an appointment, call 646-888-6024.
Social workers help patients, family, and friends deal with issues that are common for cancer patients. They provide individual counseling and support groups throughout the course of treatment, and can help you communicate with children and other family members. Our social workers can also help refer you to community agencies and programs, as well as financial resources if you’re eligible.
Tobacco Treatment Program
If you want to quit smoking, MSK has specialists who can help. Call for more information.
MSK’s Virtual Programs offer online education and support for patients and caregivers, even when you can’t come to MSK in person. Through live, interactive sessions, you can learn about your diagnosis, what to expect during treatment, and how to prepare for the various stages of your cancer care. Sessions are confidential, free, and led by expert clinical staff. If you’re interested in joining a Virtual Program, visit our website at www.mskcc.org/vp for more information.
For more online information, visit the Cancer Types section of www.mskcc.org.
External support services
In New York City, the MTA offers a shared ride, door-to-door service for people with disabilities who can’t take the public bus or subway.
Air Charity Network
Provides travel to treatment centers.
American Cancer Society (ACS)
Offers a variety of information and services, including Hope Lodge, a free place for patients and caregivers to stay during cancer treatment.
Cancer and Careers
A resource for education, tools, and events for employees with cancer.
275 Seventh Avenue (Between West 25th & 26th Streets)
New York, NY 10001
Provides counseling, support groups, educational workshops, publications, and financial assistance.
Cancer Support Community
Provides support and education to people affected by cancer.
Caregiver Action Network
Provides education and support for people who care for loved ones with a chronic illness or disability.
Corporate Angel Network
Offers free travel to treatment across the country using empty seats on corporate jets.
A place where men, women, and children living with cancer find social and emotional support through networking, workshops, lectures, and social activities.
Offers financial assistance to pay for copayments during treatment. Patients must have medical insurance, meet the income criteria, and be prescribed medication that’s part of the Good Days formulary.
Provides financial assistance to cover copayments, health care premiums, and deductibles for certain medications and therapies.
Provides a list of places to stay near treatment centers for people with cancer and their families.
LGBT Cancer Project
Provides support and advocacy for the LGBT community, including online support groups and a database of LGBT-friendly clinical trials.
Provides reproductive information and support to cancer patients and survivors whose medical treatments have risks associated with infertility.
Look Good Feel Better Program
This program offers workshops to learn things you can do to help you feel better about your appearance. For more information or to sign up for a workshop, call the number above or visit the program’s website.
National Cancer Institute
National Cancer Legal Services Network
Free cancer legal advocacy program.
National LGBT Cancer Network
Provides education, training, and advocacy for LGBT cancer survivors and those at risk.
Lists Patient Assistance Programs for brand and generic name medications.
Provides prescription benefits to eligible employees and retirees of public sector employers in New York State.
Partnership for Prescription Assistance
Helps qualifying patients without prescription drug coverage get free or low-cost medications.
Patient Access Network Foundation
Provides assistance with copayments for patients with insurance.
Patient Advocate Foundation
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This section has the educational resources mentioned in this guide. These resources will help you get ready for your surgery and recover safely after surgery.
As you read through these resources, write down any questions you want to ask your healthcare provider.
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Ileostomy – NHS
An ileostomy is where the small bowel (small intestine) is diverted through an opening in the tummy (abdomen).
The opening is known as a stoma. A special bag is placed over the stoma to collect waste products that usually pass through the colon (large intestine) and out of the body through the rectum and back passage (anus).
Stoma in a person’s tummy
Ileostomy procedures are relatively common in the UK.
When is an ileostomy needed?
Ileostomies are formed to either temporarily or permanently stop digestive waste passing through the full length of the small intestine or colon.
There are a number of reasons why this may be necessary, including:
- to allow the small intestine or colon to heal after it’s been operated on – for example, if a section of bowel has been removed to treat bowel cancer
- to relieve inflammation of the colon in people with Crohn’s disease or ulcerative colitis
- to allow for complex surgery to be carried out on the anus or rectum
Find out more about why ileostomy procedures are carried out
The ileostomy procedure
Before an ileostomy is formed, you’ll normally see a specialist stoma nurse to discuss exactly where you’d like your stoma to be (usually somewhere on the right-hand side of the abdomen) and to talk about living with a stoma.
There are 2 main types of ileostomy:
- loop ileostomy – where a loop of small intestine is pulled out through a cut (incision) in your abdomen, before being opened up and stitched to the skin to form a stoma
- end ileostomy – where the ileum is separated from the colon and is brought out through the abdomen to form a stoma
Alternatively, it’s sometimes possible for an internal pouch to be created that’s connected to your anus (ileo-anal pouch).
This means there’s no stoma and stools are passed out of your back passage in a similar way to normal.
End ileostomies and ileo-anal pouches are usually permanent. Loop ileostomies are usually intended to be temporary and can be reversed during an operation at a later date.
Read more about how an ileostomy is formed and reversing an ileostomy.
You may need to stay in hospital for up to 2 weeks after an ileostomy operation.
During this time you’ll be taught how to look after your stoma by a specialist stoma nurse.
Recovering from the procedure can be challenging. Many people experience short-term physical and psychological problems, ranging from skin irritation around the stoma to feelings of anxiety and self-consciousness.
But with practise and support from a nurse with training in stoma care, many people adjust and often find their quality of life improves after surgery.
This is especially true if they have been living with a condition like Crohn’s disease for years.
Read more about recovering from an ileostomy procedure and living with an ileostomy.
As with any surgical procedure, having an ileostomy carries a risk of complications.
Some of the problems people with an ileostomy experience include:
- a bowel obstruction – where the output of digestive waste is blocked
- vitamin B12 deficiency – caused by the removal of part of the intestine that absorbs vitamin B12
- stoma problems – such as a change in the size of the stoma making it difficult to attach the external bag
Find out more about the risks of having an ileostomy
Page last reviewed: 25 February 2019
Next review due: 25 February 2022
Incorrect End Colostomy Formation Using the Distal Bowel Limb
Michelle Feil, MSN, RN, CPPS
Senior Patient Safety Analyst
Pennsylvania Patient Safety Authority
Incorrect End Colostomy Formation
Colectomy and surgical formation of an end colostomy involves bringing the proximal, or afferent, bowel limb to the surface of the abdomen to create a stoma. The distal, or efferent bowel limb is either removed, or surgically closed and left inside the abdomen (Figure). Failure to accurately identify the correct bowel segment intraoperatively results in incorrect end colostomy formation using the distal bowel limb to create a stoma.
Figure. Anatomy of Colostomy Formation
Note: This illustration shows a descending colostomy. Colostomies may be created at other points along the length of the colon.
Closing the proximal limb creates a blind pouch, which results in bowel obstruction that requires surgical correction. The frequency of this complication is not established in the literature,1-3 but is believed to be rare.4,5 Still, this error warrants attention because it can result in serious harm to patients, at a minimum allowing exposure to the risk of undergoing an additional surgical procedure, and at a maximum leading to bowel ischemia, perforation, sepsis, shock, and death.6
“This is a technical error that is very easy to make if you are not paying attention, and it is the one error that no colorectal surgeon wants to make,”7 explained Steven Fassler, MD, Chief of Colorectal Surgery at Abington Hospital—Jefferson Health, and former president of the Pennsylvania Society of Colorectal Surgeons.
Colectomies can be performed using either an open or laparoscopic surgical approach. Laparoscopic colectomies have been steadily increasing since the 1990s, with nearly one-half of all colectomies in the United States performed using this approach.8 While this error can occur using either surgical approach, “It is much easier to make this mistake if you are performing the surgery laparoscopically,” said Fassler. “With an open case, you can visualize both ends. With a laparoscopic colectomy, it is easier to get turned around and pull up the wrong end.”
Strategies exist to prevent this complication, but even when steps are taken to ensure proper end colostomy formation, this error can occur. Because of this, postoperative physical assessment of the stoma site and bowel function is key to recognizing this error, and prompt intervention is vital to ensure a viable, properly functioning colostomy. Bowel sounds should return within 24 to 72 hours of surgery, and drainage of ostomy effluent from a properly formed stoma should be seen within several days.9 Prolonged postoperative ileus (>36 hours) requires further evaluation.5
Pennsylvania healthcare facilities reported eight events involving incorrect end colostomy formation using the distal bowel limb through the Pennsylvania Patient Safety Authority’s Pennsylvania Patient Safety Reporting System (PA-PSRS) over a 10-year period, from January 2006 through December 2015. Five of these events have been reported in the most recent four years.
All events were reported as Serious Events resulting in temporary harm, requiring treatment or intervention, and/or prolonged hospitalization.
Three of the event reports indicate that the initial surgery was performed laparoscopically. The remainder do not indicate whether the colostomies were created using an open or laparoscopic approach.
Analysis of PA-PSRS event reports reveals variation in the time intervals between the initial colectomy procedures and subsequent surgical revisions. (See Table.)
|Less than 7 days||1|
|8 to 14 days||1|
|More than 14 days||1|
The following is an example of an event reported through PA-PSRS.* Details included in the event-report narrative illustrate the harm to patients resulting from this complication and describe the physical assessment findings that helped the healthcare team to identify that this technical error had occurred:
Postoperatively, the patient’s bowel function failed to resume and the abdomen became progressively distended. The patient developed fevers and hypotension prompting transfer to the intensive care unit. Diagnostic testing revealed that the distal rather than the proximal end of the colon was used to create the stoma. The patient was returned to the operating room for revision of the colostomy.
* The details of the PA-PSRS event narratives in this article have been modified to preserve confidentiality.
Primary and secondary strategies exist to prevent incorrect end colostomy formation using the distal bowel limb. Primary prevention strategies are those that can be taken intraoperatively to prevent the wrong bowel limb from being used to create the stoma, and secondary strategies are those that can be taken postoperatively to recognize that the error has occurred and intervene in a timely fashion to correct the problem.
Fassler emphasizes the importance of checking multiple times throughout the procedure that the proximal and distal limbs are accurately identified. “I usually identify the proximal and distal limbs at least six times during the procedure,” he said. Fassler uses several different techniques to identify the distal and proximal bowel limbs intraoperatively. One is to make a mark on the distal limb using cautery. The second involves inserting a red rubber or urinary catheter into the distal limb, infusing fluid, and checking to see whether the fluid drains from the patient’s anus. And the third option, used during a laparoscopic procedure, is to leave the camera port in place, reinsufflate the abdomen, and re-insert the camera to perform a final check just prior to maturing the stoma.
Engaging other surgical team members to perform an independent double-check of the surgical site and mark is a principle encouraged by the Authority to prevent wrong-site surgery.10 Asked whether this could be done during this procedure, Fassler said, “I always have a second person scrubbed—another surgeon, a surgical resident, or a first assistant—in addition to myself and the scrub nurse. During the procedure I verbally say, ‘This is the distal limb,’ and ask if they agree. It is not part of a standardized protocol, but more of a common-sense conversation with the people involved.”
Postoperative physical assessment is key to recognizing that an end colostomy has been incorrectly formed using the distal bowel limb. Delayed recognition and failure to correct the resultant bowel obstruction in a timely fashion can result in serious harm to patients, up to and including death.6 Although no deaths were reported through PA-PSRS, it is concerning that half of the event reports describe situations in which the time that elapsed between the initial procedure and surgical revision was seven days or greater (see Table). More information is necessary to understand why these delays occurred.
Reporting to Learn
Learning from event reporting is a fundamental patient safety principle11 and the foundation of the Authority’s work. Fassler agrees, explaining that he sees the value in reporting surgical errors such as the one described in this analysis. “Everyone thinks that reporting these errors and complications is punitive, but we need to report and talk about these situations so that we can learn from them and prevent this from happening to other patients.” In fact, Fassler would encourage reporters to include as many details as possible, particularly in complicated cases. “Surgeons would like to know exactly what factors contributed to the mistake. Because what we are really trying to do is say ‘Hey, I may be facing a similar situation in the future, and I want to know what I could do to prevent something like this from happening for me and my patient.’”
Risk Reduction Strategies
The following are actions colorectal surgeons, nurses, and other surgical team members can consider to prevent and/or identify and correct this technical error:
Maintain vigilance when completing the finer technical steps involved in stoma creation, and do not delegate this task to junior or inexperienced members of the surgical team without proper supervision.2,3
Ensure that novice surgeons gain proficiency in end colostomy formation through supervised direct clinical experience, including during laparoscopic training programs.5
Mark the distal (or proximal) bowel limb intraoperatively using either a suture5 or cautery.7
Use the same method and mark the same bowel limb (i.e., either proximal or distal) each time the procedure is performed.5
Ask surgical team members to confirm identification of the proximal and distal bowel limbs whenever possible.7
Before closing the distal bowel limb, insert a red rubber or urinary catheter into the distal limb, infuse fluid, and check to see whether the fluid drains from the patient’s anus.7
Toward the end of a laparoscopic procedure, reinsert the camera through the camera port, re-insufflate the abdomen, and check to ensure that the proximal bowel limb is being pulled up to create the stoma.7
After closing the distal bowel limb, insert a flexible sigmoidoscope or colonoscope through the rectum to visualize the staple/suture line and confirm creation of a blind pouch.2,5
Once the stoma has been formed and opened at the end of the operation, instill water or air into the distal bowel limb through the rectum. If colonic contents are expressed through the stoma, the colostomy has been incorrectly formed using the distal bowel limb.2,5
Monitor the patient postoperatively to confirm the return of bowel sounds within 24 to 72 hours and the production of ostomy effluent within the first several days.9
Aside from absent or diminished bowel sounds and lack of ostomy effluent, assess the patient for additional signs and symptoms of bowel obstruction, including abdominal distension and pain.6
In patients with postoperative ileus lasting more than 36 hours, consider instilling a contrast enema through the stoma to identify errors in colostomy formation or other causes for obstruction.4,5
Incorrect end colostomy formation using the distal bowel limb is a technical error that is believed to occur rarely. Events in which this error has occurred have been reported to the Authority. Though rare, this error has the potential to result in serious harm to patients, up to and including death. Colorectal surgeons, nurses, and other surgical team members can take action to prevent this error from occurring and/or recognize the error and intervene in a timely fashion to protect patients from serious harm.
Bafford AC, Irani JL. Management and complications of stomas.
Surg Clin North Am 2013 Feb;93(1):145-66.
Shabbir J, Britton DC. Stoma complications: a literature overview.
Colorectal Dis 2010 Oct;12(10):958-64.
Shellito PC. Complications of abdominal stoma surgery.
Dis Colon Rectum 1998 Dec;41(12):1562-72.
Kann BR. Early stomal complications.
Clin Colon Rectal Surg 2008 Feb;21(1):23-30.
Fassler, Steven (MD, Chief of Colorectal Surgery at Abington Memorial Hospital, Abington Jefferson Health, Abington, PA). Conversation with: Pennsylvania Patient Safety Authority. 2016 Jun 13.
- Juo Y, Hyder O, Haider AH, et al. Is minimally invasive colon resection better than traditional approaches? First comprehensive national examination with propensity score matching [online].
JAMA Surg 2014 Feb;149(2):177–184 [cited 2016 Jul 5].
Butler DL. Early postoperative complications following ostomy surgery: a review.
J Wound Ostomy Continence Nurs 2009 SepOct;36(5):513-9.
Diverticular disease of the colon
Learn about diverticulitis and how diverticular disease is largely preventable
Many health-conscious peoplemen can recite their cholesterol counts and, blood pressure readings, and PSA levels without even glancing at their medical records. But few of these well-informed gents can tell you if they have diverticular disease of the colon, even though it’s an extremely common condition. That’s understandable, since the most prevalent form of the problem, diverticulosis, produces few if any symptoms. Still, when complications develop, blissful ignorance about diverticulosis abruptly gives way to an unwelcome education about the pain of diverticulitis or the bleeding of diverticulosis. It’s a learning experience that’s particularly unfortunate, since diverticular disease is largely preventable.
The colon is a 4 1/2-foot-long tube that constitutes the final portion of the intestinal tract. The food you eat is mostly digested in the stomach and small intestine. Residual material enters the colon, or large intestine, in the cecum, which lies in the right lower portion of the abdomen (see Figure 1). From there, digested material travels up the ascending colon, across the transverse colon, and down the descending colon to the final portion, the sigmoid colon, in the lower left part of the abdomen. The intestinal contents take about 18 to 36 hours to journey through the colon; in the process, the few remaining nutrients are snatched into the bloodstream and much of the water is absorbed, resulting in solid fecal material.
When healthy, the colon is a smooth cylinder lined by a layer of epithelial cells. The wall of the colon contains two groups of muscles, a circular muscle that rings the colon and three long muscles that run the entire length of the tube. Like all tissues, the colon requires a supply of blood; in part, it’s provided by the many small penetrating arteries that pass through the colon’s muscular wall to carry blood to its inner layer of epithelial cells.
Figure 1: The colon
Most folks who think about the colon worry about the polyps and cancers that may develop from epithelial cells. But problems can also develop in other areas. Diverticula are sac-like pouches that protrude from the normally smooth muscular layer of the colon (see Figure 2). They tend to develop where the muscles are weakest, at the places where penetrating vessels cross through the muscles. And in Western societies, the great majority of diverticula develop where the colon is narrowest, in the sigmoid.
Figure 2: Diverticulosis
Who gets diverticulosis — and why?
Age is a major risk factor for diverticulosis. Diverticulosis is uncommon before age 40, but about one-third of all Americans will develop the condition by age 60, and two-thirds will have it by age 85. That makes diverticulosis one of the most common medical conditions in the United States.
It wasn’t always this way. Diverticulosis was uncommon in the United States 100 years ago, and it’s still rare in the developing world. What accounts for the difference? The principal factor is diet, especially the refinement of carbohydrates, which has deprived the typical American diet of much of its fiber content. Diverticulosis is a disease of Western civilization.
Dietary fiber is a mix of complex carbohydrates found in the bran of whole grains and in nuts, seeds, fruits, legumes, and vegetables, but not in any animal foods. Because humans cannot digest these complex carbohydrates, dietary fiber has little caloric value — but it has plenty of health value. Among other things, the insoluble fiber found in wheat bran, whole-grain products, and most vegetables (see table) draws water into the feces, making the stools bulkier, softer, and easier to pass. Dietary fiber speeds the process of elimination, greatly reducing the likelihood of constipation.
Some sources of dietary fiber
1 cup (cooked)
1 cup (cooked)
1 cup (cooked)
1 cup (canned)
1 cup (cooked)
Pear (with skin)
Apple (with skin)
Nuts and seeds
Wheat bran (crude)
1 tsp. or 1 wafer
A low-fiber diet has the opposite effect. But constipation is the least of the problems related to diverticulosis. Without enough fiber, the stools are small and hard, and the colon must contract with extra force to expel them. That puts extra pressure on the wall of the colon — and, as you may remember from Physics 101, the Law of LaPlace explains that the pressure in a tube is highest where the diameter is smallest. In the colon, that’s the narrow sigmoid.
A Harvard study of 47,888 men demonstrates the role of dietary fiber. Men who consumed the most fiber were 42% less likely to develop symptomatic diverticular disease than their peers who consumed the least fiber. And the protective effect of fiber remained strong after the scientists took age, physical activity, and dietary fat into account.
Over time, a low-fiber diet increases the risk for diverticulosis and its complications. Because connective tissues tend to weaken over the years, age itself may compound the effect of diet. Other possible risk factors for diverticular disease include a high consumption of fat and red meat, obesity, cigarette smoking, and the use of nonsteroidal anti-inflammatory drugs. On the other hand, a Harvard study found that regular physical activity appears to reduce the risk of diverticular disease by up to 37% in men.
Diverticulosis is so common in Americans that it may hardly seem like a disease. Indeed, most peopleabout 75% of men with the condition never develop serious problems from diverticulosisit, though some of them have occasional abdominal cramps that may or may not stem from diverticulosis. But some 15% to 20% of people with diverticulosis go on to develop an inflammatory complication called diverticulitis (two-thirds mild to moderate, one-third serious) and 5% to 10% develop bleeding (two-thirds mild to moderate, one-third life-threatening). In all, diverticular disease of the colon accounts for 3,400 deaths in the United States each year while draining our economy of over $2.4 billion a year. That’s quite a toll for a disease you may never have heard of.
Inflammation puts the “itis” into diverticulitis, which is the most common complication of diverticular disease. The bacteria that are packed into feces by the hundreds of millions are responsible for the inflammation of diverticulitis, but doctors don’t fully understand why some diverticula become infected and inflamed while many do not. A current theory holds that the wall of the diverticular sac becomes eroded by pressure, trapped fecal material, or both. If the damage is severe enough, a tiny perforation develops in the wall of the sac, allowing bacteria to infect the surrounding tissues. In most cases, the body’s immune system is able to contain the infection, confining it to a small area on the outside of the colon. In other cases, though, the infection enlarges to become a larger abscess, or it extends to the entire lining of the abdomen, a critical complication called peritonitis.
Pain is the major symptom of diverticulitis. Because diverticulosis typically occurs in the sigmoid colon, the pain is usually most pronounced in the lower left part of the abdomen, but other areas may be involved. Fever is also very common with diverticulitis, sometimes accompanied by chills. If the inflamed sigmoid is up against the bladder, a man may develop enough urinary urgency, frequency, and discomfort to mimic prostatitis or a bladder infection. Other symptoms may include nausea, loss of appetite, and fatigue. Some patients have constipation, others diarrhea.
A physician’s exam may reveal tenderness over the inflamed tissues, typically in the lower left abdomen; less often, the doctor may feel swelling. As in other infections, the white blood cell counts are usually elevated. But because these findings are non-specific, further testing is required to establish a diverticulitis diagnosis. The best test is a CT scan of the abdomen, ideally performed after the patient receives contrast material both by mouth and intravenously. And a month or two later, after treatment has quieted things down, the patient should have a colonoscopy, both to evaluate the diverticular disease and to be sure that no other abnormalities are lurking.
Since bacteria are responsible for the inflammation, antibiotics are the cornerstone of diverticulitis treatment. And because the colon harbors so many bacterial species, doctors must prescribe treatment that will target a broad range of bacteria, including Bacteroides and other anaerobic bacteria that grow best without oxygen, as well as E. coli and other aerobic (oxygen-requiring) microbes. Amoxicillin–clavulanic acid (Augmentin) is effective against both types of bacteria. Another approach is to prescribe metronidazole (Flagyl, generic) for the anaerobes along with ciprofloxacin (Cipro, generic) or trimethoprim-sulfamethoxazole (Bactrim, generic) for the aerobes. Needless to say, there are many variations on the theme, and doctors must always take their patients’ allergies and general health into consideration when they prescribe antibiotics.
Patients with mild-to-moderate diverticulitis can take their antibiotics in pill form at home, but patients with severe inflammation or complications (see below) should receive intravenous (IV) antibiotics in the hospital, and then finish up with pills at home. In most cases, seven days of antibiotics is sufficient for diverticulitis treatment.
Bowel rest is also important for acute diverticulitis. For home treatment, that means sticking to a diet of clear liquids for a few days, then gradually adding soft solids and moving to a more normal diet over a week or two. Intravenous fluids can sustain hospitalized patients until they are well enough to switch to clear liquids en route to a full diet.
Because diverticulitis tends to recur, prevention is always part of the treatment plan. And for people with any form of colonic diverticular disease, that means a high-fiber diet.
Ordinary diverticulitis is bad enough, but complications from diverticular disease can be life-threatening. The most common complications include:
Abscess formation. An abscess is a walled-off collection of bacteria and white blood cells — pus. Diverticulitis always involves bacteria and inflammation, but if the body can’t confine the process to the wall of the colon immediately adjacent to the perforated diverticulum, a larger abscess forms.
Patients with abscesses tend to be sicker than those with uncomplicated diverticulitis, and they have higher temperatures, more pain, and higher white blood cell counts. Treatment involves antibiotics and bowel rest, but it also requires drainage of the abscess. In many cases, specially trained interventional radiologists can accomplish that by using CT imagery to guide a thin plastic catheter through the skin into the abscess, allowing the pus to drain out. In most cases, the catheter stays in place for several days or until the drainage stops, while the patient continues to receive antibiotics and fluids. Sometimes, though, open surgery is required (see below).
Peritonitis. Although an abscess requires aggressive treatment, it represents a partial success for the body’s infection defense apparatus, since the infection is confined to a small area. If that containment fails, infection spreads to the entire lining of the abdomen. Patients are critically ill with high fever, severe abdominal pain, and often low blood pressure. Prompt surgery and powerful antibiotics are required.
Fistula formation. In diverticulitis, the infection can burrow into nearby tissues, such as another part of the intestinal tract, the urinary bladder, or the skin. This complication is less common than abscess formation and less urgent than peritonitis, but it does require both surgery and antibiotics.
Stricture formation. It’s another uncommon complication that can develop from recurrent bouts of diverticulitis. In response to repeated inflammation, a portion of the colon becomes scarred and narrowed. Doctors call such narrowing a stricture, and they must call on surgeons to correct the problem so fecal material can pass through without obstruction.
Most patients with uncomplicated diverticulitis respond well to antibiotics and bowel rest. The majority of patients with abscesses do well with drainage through a catheter, but patients with severe diverticulitis or threatening complications require surgery. Here are some typical indications for diverticulitis surgery:
- Severe diverticulitis that does not respond to medical treatment
- Diverticulitis in patients with impaired immune systems
- Diverticulitis that recurs despite a high-fiber diet
- Abscesses that cannot be drained with a catheter
- Peritonitis, fistula formation, or obstruction
- Strong suspicion of cancer.
The timing and type of operation depend on the patient’s individual circumstances. One traditional approach involves two separate operations, the first to remove the disease and divert the intestinal contents to a colostomy bag on the skin, and the second, several months later, to hook the colon and rectum back together (see Figure 3). In some cases, this can be accomplished with less-invasive laparoscopic surgery, and in milder cases, one operation may suffice. Still, the prospect of surgery makes a good case for eating plenty of fiber (see below).
Figure 3: Two-stage surgery for diverticulitis
Diverticulitis is one main complication of diverticular disease of the colon. The other is diverticular bleeding. It occurs when a diverticulum erodes into the penetrating artery at its base (see Figure 2). Because acute inflammation is absent, patients with diverticular bleeding don’t have pain or fever.
The most common symptom is painless rectal bleeding. Since diverticular bleeding occurs in the colon, it produces bright red or maroon bowel movements. (In contrast, when bleeding occurs in the stomach, the blood is partially digested as it passes through the intestinal tract, so it appears as black, tar-like bowel movements).
In most patients, the bleeding is mild, and it usually stops on its own with bowel rest. But brisk bleeding is a life-threatening emergency. It requires expert hospital care with blood transfusions and IV fluids. It also requires aggressive attempts to locate the site of bleeding and to stop it. Several techniques are available; most experts recommend colonoscopy (doctors can see the bleeding artery through the scope and cauterize or clip it to stop the bleeding) or angiography (doctors thread a catheter into the artery that supplies blood to the colon, inject dye to see the bleeding artery on x-rays, and then inject medication to constrict the artery and stop the bleeding). If neither approach stops the bleeding, surgery may be needed.
Diverticular disease prevention
Diverticular disease of the colon is preventable. A high-fiber diet will sharply reduce the risk of developing diverticula — and even after the pouches form, dietary fiber will reduce the risk of diverticulitis and diverticular bleeding.
The Institute of Medicine recommends 38 grams of fiber a day for men age 50 and under and 30 grams a day for older men. For women, the recommended amount is 30 grams a day for those age 50 and under and 21 grams a day thereafter. Most Americans get much, much less. The table lists the fiber content of some foods and supplements.
Fiber is important for bowel function and general health, but it can be hard to get used to. Many people feel bloated and gassy when they start a high-fiber diet, but if they stick with it, these side effects usually diminish within a month or so. Still, it’s best to ease into a high-fiber diet. Increase your daily intake by about 5 grams per week until you reach your goal, and be sure to have plenty of fluids as well. For most people, a high-fiber cereal is the place to start, but if breakfast isn’t your thing, you can have it any time during the day.
Until recently, doctors banned nuts, seeds, corn, and popcorn from the diet of diverticulosis patients. Although they had no real evidence that these foods were harmful, doctors worried that these small particles might pass into the colon undigested and then lodge in the mouth of a diverticulum, blocking the pouch and making things worse. But a 2008 Harvard study put these fears to rest. During the 18-year study, the men who ate the most nuts and popcorn actually had a lower risk of acute diverticulitis than the men who ate the least; there was no change in the risk of bleeding, for better or worse.
Scientists are experimenting with other ways to prevent attacks of diverticulitis and episodes of bleeding; among other things, long-term nonabsorbable oral antibiotics are under study. People with diverticular disease might be wise to avoid or minimize their use of nonsteroidal anti-inflammatory drugs, which may (or may not) increase the risk of trouble. Even so, dietary fiber remains the key to preventing diverticulitis and its complications. And if that’s not enough reasons to chow down lots of “roughage,” consider the other benefits of a high-fiber diet.
Dietary fiber fights constipation. Because it reduces straining that puts pressure on the abdomen and the veins, fiber reduces the risk of hernias, hemorrhoids, and even varicose veins. In some, but not all, studies, fiber has been linked to a reduced risk of colon cancer. Fiber is filling, and it helps combat obesity. It improves blood sugar metabolism, lowering the chances of developing diabetes. It lowers blood pressure. Some forms of fiber (soluble fiber) reduce blood cholesterol levels, and according to a Harvard study of 43,757 men, a high-fiber diet appears to reduce the risk of heart attacks by 41%.
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Small intestine endometriosis – laparoscopic surgery, laparoscopy [Video]
A patient with retrocervical endometriosis and two large cysts on the ovaries
A patient with retrocervical endometriosis and two large cysts on the ovaries. Professor Puchkov K.V. is performing an operation (2020).
During the operation, my goal is to carefully excise the cysts, completely preserving the ovarian tissue, since
the patient is planning a pregnancy in the future, carefully approach the large intestine, as much as possible
preserving its affected area and excise all endometrioid foci.
You can read more about the technique on the personal website of Professor Konstantin Viktorovich Puchkov go to
Results of surgical treatment of retrocervical endometriosis with lesions of the sigmoid, rectum, cecum and ileum using laparoscopic access.
Professor Puchkov K.V. is performing an operation (2018).
Patient 32 years old, with deep infiltrative retrocervical
endometriosis of the sacrouterine ligaments and lesions of the sigmoid,
rectum, cecum and ileum, operated with laparoscopic
access.Repeated laparoscopy with assessment of the result was performed after
During the primary operation, the invasion of the sigmoid colon was revealed in
two places with more than 50% stenosis of the lumen. Defeat straight and
ileum with wall invasion to the submucosal layer.
The defeat of the cecum over the entire thickness of the wall. For the best
visualization of the operating field, temporary fixation is performed
ovaries with transabdominal sutures. The film shows a safe
technique of excision of endometriosis of the sacrouterine ligaments and “shaving”
rectum with a 5 mm monopolar electrode.Next 5 mm tool
Liga Sure MEDTRONIC COVIDIEN mesenteric dissection performed
the sigmoid colon and the intersection of the distal section by linear
endoscopic stapler immediately after the infiltration. Then
removing the affected area to the anterior abdominal wall,
cutting off the intestine directly at the infiltrate and inserting the head
stapler to the leading department, with the formation
circular colonic anastomosis end-to-end apparatus
MEDTRONIC COVIDIEN 31 mm laparoscopic approach.
At the second stage, resection of the dome of the cecum with an endometriotic focus was performed using a linear endoscopic stapler. The trocar wound in the right iliac region was enlarged to 3 cm, and the affected area of the ileum was brought out to the abdominal wall. Then the endometriotic lesions were “shaved” to the submucosal layer with a thin monopolar electrode. Defects of the intestinal wall were sutured with a manual suture with Polysorb 4-0 thread on an atraumatic needle. The intestine is immersed in the abdominal cavity. The surgical area was treated with anti-adhesive gel.In the postoperative period, therapy with Dipherelin 3.75 mg IM was carried out for 6 months.
Repeated laparoscopy with assessment of the result was performed after 1.5 years. During the operation, no adhesions were found in the abdominal cavity, the zones of excised infiltrates were covered with the parietal peritoneum. In the area of the colon anastomosis and the suture on the cecum, thin scars are determined. In the place of the shaving of the lesion on the ileum, a delicate stellate scar is determined. The treatment result was assessed as excellent.
You can read more about the technique on the personal website of Professor Konstantin Viktorovich Puchkov go to
Laparoscopic approach in the treatment of retrocervical endometriosis with small bowel involvement
Laparoscopic approach in the treatment of retrocervical endometriosis with small bowel involvement.Professor Puchkov K.V. is performing an operation (2016).
A 34-year-old female patient with deep infiltrative retrocervical endometriosis and lesions of the ileum. The video shows the technique of excision of the endometrioid foci of the pelvic peritoneum with a 5 mm monopolar electrode. The revision revealed a lesion of the ileum with invasive endometriosis 4 cm from the ileocecal angle 6 cm long. The lesion invaded all layers of the intestinal wall with the formation of stenosis of the lumen of the organ. The trocar wound was enlarged to 4 cm, and the affected area of the intestine was brought out to the abdominal wall.The resection of the small intestine was performed, with the dissection of the mesentery directly at the intestinal wall, with the preservation of the terminal branches a. ileocolica. This made it possible to form an end-to-end anastomosis directly at the large intestine by hand suture with Polysorb 4-0 thread on an atraumatic needle. The suture line is additionally reinforced with a Tachocomb hemostatic plate (Austria). The anastomosis is immersed in the abdominal cavity. The duration of the operation is 120 minutes.
You can read more about the technique on the personal website of Professor Konstantin Viktorovich Puchkov go to
Laparoscopic approach in the treatment of endometrioid ovarian cysts with extensive lesions of the small intestine (“shaving” foci)
Laparoscopic approach in the treatment of endometrioid ovarian cysts with extensive lesions of the small intestine (“shaving” foci).Professor Puchkov K.V. is performing an operation (2015).
A 32-year-old female patient with endometrioid ovarian cysts, external genital endometriosis and extensive lesions of the ileum. The video shows that laparoscopy revealed a lesion of the ileum with invasive endometriosis. Infiltrates are determined over a length of 25 cm (10 foci from 3 to 8 mm) with deformation of the intestinal wall without involvement of the submucosal layer. The trocar wound in the right iliac region was enlarged to 4 cm, and the affected section of the intestine was brought out to the abdominal wall.Then, all the lesions were “shaved” to the submucous layer of the small intestine with a thin monopolar electrode. Defects of the intestinal wall were sutured with a manual suture with Polysorb 4-0 thread on an atraumatic needle. The intestine is immersed in the abdominal cavity. The surgical area was treated with anti-adhesive gel. The duration of the operation is 90 minutes.
90,000 Diagnostics and treatment of rectal cancer at the EMC Institute of Oncology in Moscow
Anvar Yuldashev, a coloproctologist, an oncologist surgeon, Ph.M.Sc.
Rectal cancer is a malignant tumor that develops more often from cells of the mucous tissue lining the rectum, less often from muscle cells, blood vessels, transitional epithelium of the anal canal, anal glands, perianal skin.
The rectum is the last link in the digestive system and is the final section of the large intestine located in the small pelvis. Currently, rectal cancer accounts for about 4-5% of all cancers and about 70% of all bowel cancers.
Most often, a rectal tumor is detected at the age of 50-60 years, but it can appear at the age of 20-30 years. In view of the danger of the disease, timely treatment of rectal cancer is necessary.
Rectal cancer risk factors
Age over 40 years
Oncologically burdened heredity
Molecular genetic hereditary syndromes:
Inflammatory Bowel Disease:
Primary sclerosing cholangitis
Race and gender (more often in men, in blacks)
Diabetes mellitus and insulin resistance.
Eating red meat
History of cholecystectomy
Rectal cancer: clinical presentation
Cancer in the early stages does not have pronounced symptoms, however, with the growth of the tumor, the patient develops a feeling of dull pain when passing feces, secretion of mucus and blood with stool.Note that the symptoms of a rectal tumor can be very similar to the manifestation of internal hemorrhoids.
In the later stages, intestinal obstruction, bleeding, as well as inflammatory complications are observed: peritonitis, phlegmon, abscess. The tumor can grow into the bladder, vagina, sacrum, cause compression of the ureters, etc.
Diagnosis of rectal cancer
The most important and simplest method for diagnosing a tumor is a digital examination of the rectum, but patients often ignore this method of examination during preventive examinations.
The second method of examination is sigmoidoscopy or colonoscopy, which allows you to combine the examination of the rectum with a biopsy. This examination is extremely necessary.
The third method is endoscopic examination, which reveals a picture similar to colon cancer.
Additional methods of examination include ultrasound and computed tomography, positron emission tomography – assessment of the prevalence of a tumor in the body, laboratory diagnostics – assessment of the level of tumor markers, assessment of the degree of impairment of the kidneys and liver.
Stages of rectal cancer
Stage 1 – The tumor infiltrates the intestinal wall to the submucosa, or the muscular layer of the intestinal wall. No metastatic lesions of regional lymph nodes, no distant metastases.
Stage 2 is divided into substages IIA and IIB.
Stage IIA – Tumor infiltrates subserosis or tissue of non-peritoneal colon and rectum.
Stage IIB – The tumor invades the visceral peritoneum or directly spreads to adjacent organs and structures.
The second stage is characterized by the absence of metastatic lesions of regional lymph nodes, the absence of distant metastases.
Stage 3 is divided into three substages:
IIIA – The tumor infiltrates the intestinal wall to the submucosa, or the muscular layer of the intestinal wall. Metastatic lesion of three or less regional lymph nodes.
IIIB – The tumor infiltrates subserosis or tissue of non-peritonized areas of the colon and rectum, or the tumor invades the visceral peritoneum or directly spreads to adjacent organs and structures.Metastatic lesion of three or less regional lymph nodes.
IIIC – Any of the above volume of primary tumor involvement. Metastatic lesion in four or more regional lymph nodes.
The third stage is characterized by the absence of distant metastases.
Stage 4 – any volume of the primary tumor and any number of metastatic regional lymph nodes. The presence of distant metastases.
Rectal cancer treatment
Currently, there are 3 methods of treatment:
Rectal cancer treatment: operation
Surgical treatment of rectal cancer is the main method of therapy.Depending on the size and location of the tumor, 4 main operations are performed: intra-abdominal resection or anterior rectal resection, low anterior rectal resection, rectal extirpation, Hartmann’s operation.
If the tumor is localized in the upper third of the rectum, then anterior rectal resection (intra-abdominal approach) is performed.
Anterior resection is the removal of the affected colon followed by suturing of its ends. Stitching takes place with the help of special devices, as well as manually, in some cases you cannot do without it.Note that with intra-abdominal resection, the sphincter is preserved, only the section of the intestine with the tumor is removed. This operation has the best functional results, but it is not always possible to carry out it due to the large size of the tumor or the anatomical features of the patient.
If the tumor is located in the middle part of the rectum, but higher than 6 cm from the edge of the anus, then a low anterior rectal resection is performed. The stitching of the intestine takes place with the help of special staplers. The operation is significantly better than the abdominal anal resection, since it preserves the sphincter apparatus of the anal canal.
Previously, instead of a low anterior resection, an abdominal-anal resection of the rectum was performed – when the affected intestine is removed, the “upper” end of the intestine is pulled inside the “lower” one, after which they wait for fusion and only then the excess of the intestine extended into the anus is cut off. This operation was the most common, since it allowed to remove the tumor without harming the oncological radicalism and partially preserved the sphincter apparatus.
For rectal cancer complicated by perifocal inflammation, acute colonic obstruction, Hartmann’s operation is performed.In this case, the tumor is removed, after which the “upper” end of the intestine is removed in the form of a temporary or permanent colostomy (artificial anus), and the “lower” end is sutured. Hartmann’s operation is performed when it is too risky to suture the ends of the intestine.
If the tumor is below 6 cm from the edge of the anus, the most justified oncological operation is abdominal-perineal extirpation of the rectum, which can be completed by removing the colostomy on the abdomen or forming a colostomy on the perineum, in the place of the pre-existing anus.
During abdominal-perineal extirpation, the rectum is removed completely together with the sphincter apparatus and a colostomy is formed, which cannot be removed afterwards. This operation is used when the tumor is located very close to the anus and when it is impossible to perform an abdominal anal resection.
Rectal cancer treatment: radiation therapy
Radiation therapy for rectal cancer is often used before or after surgery and in combination with chemotherapy.The use of radiation therapy can shrink the tumor and facilitate its removal, as well as avoid colostomy and reduce the risk of a new tumor.
Rectal cancer treatment: chemotherapy
Chemotherapy is used for the treatment of tumor metastases, as well as for the prevention of metastases after surgery. It has been proven that the use of chemotherapy increases the life expectancy of patients with metastases of rectal cancer.
The effectiveness of the treatment of oncological diseases, first of all, depends on the equipment and methods.The European Medical Center has the most modern equipment, the latest methods of therapy, the staff includes the best doctors in Russia and Western Europe, who have extensive experience and practice in leading European clinics.
90,000 Anterior rectal resection – the course of the operation, technique, reviews.
Anterior rectal resection is an operation, during which the affected part of the intestine is removed. The operation is performed for a malignant tumor of a small size, localized in the rectosigmoid or upper ampullar region, 10 cm above the anus.At the same time, nearby tissues are also removed: a segment of the intestine, regional lymph nodes, vessels. In the case when the malignant tumor is 8 cm higher than the anal sphincteran, an atotal mesorectumectomy is indicated – a low anterior resection of the rectum. During the operation, a large part of the intestine is removed up to the sphincter, and to replenish the lost reservoir capacity of the rectum during an operation, a “reservoir” is formed from the superior part of the intestine.
Both methods are sphincter-preserving – there is no need for the formation of a colostomy (removal of a part of the intestine to the abdominal wall), although it is possible that it may be necessary to create a temporary stoma – when performing a low resection of the intestine, its closure is possible after a couple of months.
With this technique, the remaining part of the rectum will be enough to form an anastomosis – to connect the ends of the intestine, thus ensuring the continuity of the intestine. As a result, the anal sphincter and the ability to naturally empty the bowels are preserved. Moreover, thanks to the availability of modern equipment and instruments that our clinic is equipped with, the nerve fibers located in the small pelvis and necessary to control urination and preserve sexual function are also preserved.At the end of the recovery period, patients quickly return to life without restrictions.
Indications and contraindications
- tumor of a malignant nature of small size in the upper ampullary or rectosigmoid part of the rectum;
- terminal cancer,
- severe concomitant diseases,
- some blood diseases.
Advantages of anterior rectal resection
- Rectal resection is a sphincter-preserving operation, which allows you to preserve the possibility of natural bowel emptying;
- Due to the formation of the anastomosis, the continuity of the intestine is preserved;
- Absence of significant blood loss during the intervention;
- A short period of rehabilitation, after which patients return to their normal life without any restrictions.
Why is it better to perform anterior rectal resection at the Swiss University Hospital?
- The clinic was one of the first to perform sphincter-sparing surgeries; today the number of bowel surgeries has exceeded 3000 operations.
- We employ specialists of the highest category, many of whom, being authorities in surgery, are known not only in domestic but also foreign clinics.Each of our specialists is fluent in all techniques and can perform more than 100 types of operations within the framework of their specifics.
- Every year we consult about 5 thousand people, including patients with proctological pathologies referred from other clinics.
- For diagnostics, our Center carries out almost all the necessary research: from laboratory tests to the most complex examinations using video endoscopic or computer technology.Due to the presence of a histological laboratory, the time for examining patients is minimal, which is extremely important in patients with oncological diseases.
- If necessary, doctors of other specializations can be involved in the diagnosis and treatment of patients with concomitant diseases: endocrinologists, gynecologists, vascular surgeons, etc.
- We were one of the first to carry out simultaneous operations: during one anesthesia, a patient can get rid of other pathologies of the abdominal cavity or pelvic organs.
Frequently Asked Questions
What is the preparation for anterior rectal resection?
Before surgery, radiotherapy can be prescribed, the purpose of which is to reduce the size of the formation, as well as reduce the likelihood of recurrence in the future. A few days before the procedure (about 4-5), foods high in fiber should be excluded from the diet. In this case, the intestines are cleansed with the help of cleansing enemas or laxative drugs.A cleansing enema is also performed on the day of surgery. On the eve – food of only liquid consistency, the last meal – at least 8 hours before the intervention. Also, before the operation, antibacterial drugs can be prescribed, the action of which is aimed at destroying the pathogenic bacteria present in the intestine. In addition, it may be necessary to temporarily cancel medications that affect the properties of the blood, therefore, the doctor should be informed about all medications taken.
What are the types of operations?
Resection can be performed by laparotomy; open surgery allows you to determine the state of the abdominal cavity, to detect possible changes in tissues in the tumor area, which ensures the complete removal of malignant cells within the tissues not affected by the process. At the initial stages of the disease, it is possible to conduct laparoscopy, with this method the rehabilitation period is shorter, after healing on the abdominal skin, there are practically no signs of the operation.
Does anterior rectal resection have disadvantages?
During the operation, an anastomosis is formed, ensuring the continuity of the intestine, however, with low resection, it is located near the anus. To exclude the possibility of fecal masses getting into the anastomotic zone during the surgical intervention, a temporary stoma is formed – the end of the intestine is brought out to the anterior abdominal wall. After the anastomosis has healed, usually after a couple of months, the stoma is closed – a reconstructive operation, thanks to which it becomes possible for the patient to empty naturally.
Is there a risk of complications with anterior rectal resection?
During the operation, there is theoretically a risk of bleeding or damage to nearby organs, but the intervention by experienced surgeons minimizes the likelihood of such complications. In the early postoperative period, there is a risk of developing respiratory and cardiovascular failure, thromboembolic complications, therefore, in our clinic in the first days after the operation, patients are under constant supervision of surgeons.Complications as a result of insufficient anastomotic sutures can cause the appearance of an abscess or phlegmon in the retroperitoneal space or perrectal tissue. In addition, there is a risk of the formation of fecal fistulas, peritonitis. In order to avoid such complications, it is better to carry out the operation in a clinic equipped with modern equipment, it is also important to comply with all the recommendations of the attending physician.
How is rehabilitation going?
In order to prevent the development of thrombosis and respiratory failure, early activation of the patient is practiced, at first it is only turning from side to side, but gradually the volume of motor activity increases.Particular attention should be paid to nutrition in the postoperative period, during the first week, food is served only in a liquid consistency, the diet expands gradually. Hospitalization lasts 7-10 days. To reduce the tension of the abdominal muscles, the operated patient is recommended to wear a special bandage. In the first month after surgery, you should limit the consumption of foods containing fiber.