THERE are four general reasons for the construction of a colostomy in the management of rectal carcinoma: (1) as a palliative measure when an unresectable cancer is present; (2) as a temporary expedient to divert the fecal stream during a course of tumor coagulation or of radiation therapy; (3) as a temporary measure to protect a difficult, low-lying anastomosis; and (4) as a part of an abdominoperineal resection done for cure or palliation.
When a rectal cancer cannot be cured by surgery, an abdominoperineal resection nevertheless provides the best palliative procedure. A colostomy alone, even a double-barrel stoma in the sigmoid colon, provides only partial relief. Although bleeding is controlled to a great degree, the very bothersome symptom of tenesmus, produced when the bowel attempts to move an intraluminal mass forward by a peristaltic wave, is not controlled. Nevertheless, if the cancer is frozen into the pelvis or if the
Morton JH, Kinsella EM. The Colostomy. JAMA. 1975;232(2):185–186. doi:10.1001/jama.1975.03250020055031