Double Barelled Wet Colostomy (DBWC) and Total Pelvic Exenteration

The majority of people who require a stoma formed will only have one stoma to contend with.

  • A colostomy which is where an end of the large bowel is brought out which can be temporary or permanent
  • An ileostomy where the end of the small bowel (ileum) is brought out and is either temporary or permanent.
  • An ileal conduit/urostomy which is usually permanent and is where the bladder is removed (or sometimes left insitu and bypassed) and a segment of small bowel is used as a conduit and the ureters leading from the kidneys are plummed into it and brought out on to the surface of the abdomen.

However in a very small number of people due to their disease progression they will require two stomas formed an ileal conduit and a colostomy.

Prognosis, treatment and life expectancy is continually improving for people who are undergoing such life changing surgery.

Ladies who require a Total Pelvic Exenteration is for those who have ovarian cancer which has usually spread from the ovaries or womb into the bowel and bladder. The operation requires removal of the ovaries, tubes leading from the ovaries, a complete hysterectomy, the bladder (cystectomy) and possibly part of the urethra which is the tube leading from the bladder where urine is passed from.

In men the operation is similar except they will have had cancer of the prostate gland which has spread into the bladder and rectum. In men a Total Pelvic Exenteration means removing the prostate gland if still there, the seminal glands and the bladder (cystectomy) and urethra.

In both sexes it may be a primary or recurrence of the cancer and they will probably have had radiation damage and they will have two stomas formed a colostomy typically on the left hand side and a urostomy typically on the right hand side and the bottom is sewn up and a small part of muscle is sewn into the perineum in order to help with movement.

A Double Barreled Wet Colostomy is a relatively old operation which fell out of favor in the USA in the 1940’s however it has now been updated and surgically improved and is being carried out in some hospitals in the UK mainly The Royal Marsden.

The DBWC is a major operation performed where cancer has spread into both bladder and bowel or where there has been severe radio therapy damage and a Total Pelvic Exenteration is carried out it offers an alternative operation for people who require two stomas a Urostomy/ ileal conduit on the right hand side of the abdomen and a colostomy on the left hand side of the abdomen people can now have one stoma on the left hand side which means only wearing one pouch instead of two.

A loop colostomy is formed, the bladder is removed and an ileal conduit made and the ureters are transplanted and urine is diverted into the loop of the large bowel, and a colostomy brought out just above the urinary stoma, on the left hand side of the abdomen – it is easier for the surgeon to bring out the large bowel through the muscle on the left hand side.

The surgeon removes part of a muscle usually from the abdomen which is inserted into the bottom, this allows for more movement otherwise the bottom can become tight and painful. The end of the rectum is sewn up and the stool will now exit via the colostomy, with the urine and stools draining into a single pouch.

Discussion prior to the operation.
The Consultant will would have discusse a DBWC with you as an alternative to having two stomas formed and discussed in great detail the benefits and disadvantages of having only one stoma. The Stoma Care Nurse will also talk you through the management of only having one stoma where the stool and urine exits. This is a very big operation and a big commitment is required by the patient and their spouse or carers.

Appliances.
The B Braun High output pouch is at present the most suitable urine it comes in a one piece appliance and a two piece appliance which gives patients some choice. The pouch can have attached a night drainage bag at night time as it has a wide tubing to allow the flow of stool and urine.

After going home you may be taught how to irrigate your colostomy so that only urine drains into the pouch and then you can wear a standard urostomy pouch if this is suitable for you. However it is as always a personal choice.

Article with thanks to Gill Hopkins