Management of the Permanent Colostomy

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The term, colostomy, or artificial anus, is of ominous significance to the patient. However, it is interesting to follow the change in his attitude from doubt and depression, through increasing confidence, and finally to personal pride in his ability to manage the artificial opening. As he begins to realize that he can actually lead a normal life despite this handicap, depression is replaced by planning for the future.

Many physicians who refer patients ultimately requiring colostomy to a surgeon see only a few such cases in the ordinary practice of medicine and as a result have little experience in its management. Since these same patients will return with many of their problems to the referring physician, we feel that our experience in dealing with such problems might well be described.

In the past five years we have had the opportunity to follow several hundred patients with permanent colostomies. These patients were interviewed preoperatively, were operated upon at Cleveland Clinic, and were followed postoperatively from six months to ten years. The procedures carried out with all of these patients will be described.

Preoperative Care

The care of this type of patient begins at the time he is first told that an operation will be necessary. Invariably his first question is, "Will I lose the function of my rectum?" To be too brusque and straightforward at this time may be a psychological mistake and lead to much mental anguish. Falsehood and evasion are also unwise and unnecessary. One needs only to reassure. . .



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