What Happens After a Total Colectomy?

A total colectomy is the removal of the entire large intestine and sometimes the rectum and anus. The reasons people get a total coletctomy include advanced colon cancer, extensive irritable bowel disease, or as a prophylactic measure for someone at high risk for colon cancer.

If you are about to have a total colectomy, you may be wondering how you will maintain proper bowel functions after your colon is removed? Here are some possible scenarios you may face after a total colectomy.

Ileal pouch-anal anastomosis (IPAA)
With this procedure, the entire colon and rectum have been removed and a pouch is formed between the end of the small intestine (called the ileum) and the anus to hold fecal waste. While this heals, a temporary ileostomy (see below) is also performed so the client can eliminate waste. Once healed, the ileostomy is closed and the client can resume normal bowel movements through the anus.

Ileostomy/colostomy
A colostomy is a surgical procedure involving an opening (called an ostomy) in the abdomen to allow the body to excrete fecal waste from the colon. Specifically, an ileostomy is an ostomy made from the ileum of the small intestine. If the ileostomy is temporary, it will be closed after 2-3 months. However, if the client has his entire colon, rectum, and anus removed, the ileostomy is permanent. This procedure is known as total proctocolectomy with permanent ileostomy . For more information on colostomies, read my article here.

Kock pouch
Also called a continent ileostomy. This procedure involves the removal of the entire colon and anus and a pouch is attached to the end of the small intestine. A stoma is then formed in the abdominal wall with a one way nipple valve (to prevent leaking) and the client will be taught how to insert a tube to drain the pouch of feces.

Before you have your total colectomy, you will meet with an enterostomal (ET) nurse so she can mark the site for the ileostomy. This will most likely be the lower right side of the abdomen. The site for the ileostomy will be chosen based on what best fits your natural movements. You will be asked to stand, sit up, sit down, and lie down so natural movements can be noted. The ET nurse will also educate you on care of your ileostomy, what medications you will be taking, diet, hygiene, and clothing once the ileostomy is in place.

Note: this article is for informational purposes only. If you are going to have a total colectomy, please consult with your doctor about which procedure is right for you.

Sources:

LeMone, Priscilla & Burke, Karen (2008). Medical-Surgical Nursing-Critical Thinking In Client Care (4^th ed.). Upper Saddle River NJ: Pearson Prentice Hall pp 788-789.

United Ostomy Associations of America website