The term colostomy is intended to indicate the operation when any part of the colon is brought out, attached to the skin and opened for the purpose of diverting the intestinal contents from further progress in the bowel below the opening. Colostomy is divided into five different varieties, dependent upon the position of the opening, as follows: 1. Left inguinal. 2. Right inguinal. 3. Transverse. 4. Right lumbar. 5. Left lumbar.

The left inguinal and left lumbar colostomy are the only two generally performed unless emergency forces the selection of one of the other varieties. The left inguinal and left lumbar are physiologically the most desirable sites for the establishment of an artificial anus.

Colostomy is indicated under the following conditions. 1. Ulcer of the rectum and lower sigmoid, due to catarrh diseases, tuberculosis, syphilis or dysentery. 2. Recurrent and inoperable stricture with symptoms of auto-intoxication, which endanger life. 3. Non-malignant growths. 4. Adenoidal and polyp, with symptoms of septic infection. 5. Congenital malformations, when there is an condescended rectum which cannot be brought down into its normal position, or where an Atreus vesicles or Atreus urethurethral is exists, endangering life and necessitating the turning aside the fecal current. 6. Cancer.

Colostomy is performed for the purpose of establishing either a permanent or temporary artificial anus through which the feces are expelled. The sigmoid flexible, transverse colon, or the ascending colon are sutured to the skin and opened in these operations.

Permanent Left Inguinal Colostomy is most commonly performed with the idea of permanently diverting the fecal current to relieve the irritation and obstruction from cancer, sarcoma, stricture, and non-malignant growths. It is an operation which may be performed under local anesthesia, if necessary.

The Operative Technique for the permanent left inguinal colostomy is as follows: The abdomen is prepared as for any abdominal operation, and a two and one-half inch incision is made about one and a half or two inches from the inner side of the left anterior superior spine of the ilium, almost at right angles to an imaginary line drawn from the anterior superior spine to the umbilicus, or Tourney’s point on the left side. The incision is made through the skin down to the abdominal muscles, which are separated without cutting. The peritoneum is divided between two thumb forceps and brought up and sutured to the skin with catgut, immediately if desired. The sigmoid, as a rule, can be found with the index finger as the first piece of gut which presents itself. It can be easily recognized by the longitudinal bands, the presence of the appendices epicycloid, also by its large size, thick walls and speculations A portion should be selected which will allow the formation of a proper spur without forming too sharp an angle or interfering with the circulation of the blood supply to the gut. If too long, a portion of the bowel may be amputated in order to overcome the providential which follows in these instances.

A portion should be chosen which permits the gut to enter the abdominal wound by pulling the intestine until it is taut, both from above and below the opening, which then forms an acute angle on the inner surface of the protruding gut, making a spur. The bowel is now fastened to the abdominal wall by silk or chromite catgut sutures, passed through the skin, abdominal muscles, peritoneum, and the longitudinal band of the gut on one side, then reintroduced through the longitudinal band at the other side and carried back in the same manner and tied on the skin surface, one-half inch from the point of introduction. This suture draws the upper and lower ends of the loop of gut together and thus anchors it to the wound. The abdominal incision is then shortened by sutures of catgut passed through the skin, abdominal muscles, and longitudinal band of one side and brought up through the muscles and skin of the other side, where it is tied.

This should shorten the entire length of the wound to about one and a half inches. One or two additional sutures may be put into the wound if necessary. Hernia of the gut is prevented by introducing several interrupted catgut sutures about one-half inch apart, which include the skin, the serous and muscular coats of the intestinal wall. A piece of gauze or rubber tissue smeared with a sterile Vaseline is placed over the protruding gut and sufficient sterile pads placed about the wound, to protect the gut from undue pressure from the outer dressings and abdominal binder, which is applied later.

The bowels should be controlled with morphine for several days, dependent upon the comfort of the patient and distention of the abdomen. The bowel should be amputated about one-fourth inch from the skin, two to four days after operation, dependent upon the urgency or the comfort of the patient, as adhesion should be formed entirely around and between the abdominal wall within that time. The wound is again dressed with sterile gauze and the patient kept in bed for a week or ten days according to the conditions of the wound.

Temporary Left Inguinal Colostomy. This operation is indicated for temporary use, but may be converted at any time into the permanent variety. As a rule it is only applied to those cases that cover a period of from one to six months and includes affections such as syphilis, dysentery, tuberculosis, traumatic ulcerations, hypertrophy catarrh conditions and specific colonic infections. It is also a preliminary operation for diverting the fecal current prior to resection of the rectum or sigmoid for cancer, stricture or other indications. The first steps of the operation are the same as for the formation of permanent colostomy, but the manner of opening the gut differs. The bowel is not completely divided in this procedure, so as to afford an opportunity to close the opening later.