Yes, Bowel Movements Through a Diverting Loop Sigmoid Colostomy at 5 Days Post-Op Are NOT Normal
A properly constructed diverting loop sigmoid colostomy should completely divert the fecal stream, meaning the patient should NOT be having bowel movements through the distal rectum at 5 days post-operatively. 1
Understanding Loop Colostomy Function
Loop colostomies are designed to be totally diverting when properly constructed:
Complete diversion is expected: Research using barium studies demonstrated that loop colostomies constructed over a rod and matured immediately completely divert the fecal stream, with no passage of barium into the distal limb even after 24 hours or following bowel preparation 1
Normal colostomy output timing: A functioning colostomy typically begins producing output within 1-3 days post-operatively, with mean time to first output around 1.9 days 2
Expected output characteristics: Normal colostomy output should be formed stool occurring once daily through the stoma appliance 3
What This Means Clinically
If your patient is having bowel movements through the rectum at 5 days post-op with a diverting loop sigmoid colostomy, this suggests:
The colostomy may not be adequately diverting - This is the most concerning possibility and warrants immediate evaluation 1
Possible technical issue with construction - The loop may not have been properly matured or the rod/bridge may have been removed prematurely 1
Residual stool clearance is unlikely - While colonic motility is essentially abolished distal to a properly functioning diverting stoma, with radiopaque marker studies showing no movement of markers at day 5 post-operatively 2, any ongoing bowel movements suggest inadequate diversion
Immediate Assessment Required
You should evaluate for:
Stoma examination: Verify the stoma is properly constructed with clear identification of proximal and distal limbs 1
Volume and frequency: Document whether these are true formed bowel movements versus minimal mucus discharge (which would be normal) 3
Clinical signs of anastomotic leak: If this colostomy was created to protect a distal anastomosis, inadequate diversion increases leak risk significantly 2, 4
The presence of actual fecal material passing through the rectum indicates the diversion is incomplete and requires urgent surgical consultation to assess stoma function and consider revision if necessary. 1