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April 14, 1975

The Colostomy

Author Affiliations

From the departments of surgery (Dr. Morton) and medical oncology (Ms. Kinsella), University of Rochester School of Medicine and Dentistry, and Strong Memorial Hospital, Rochester, NY.

JAMA. 1975;232(2):185-186. doi:10.1001/jama.1975.03250020055031

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