What is a double barrel stoma?
There are several types of stoma surgery, and the one a surgeon creates depends on the reason for the operation and which section of bowel is involved. With a double barrelled stoma (which is sometimes also written as a double barreled stoma), the bowel is resected — separated into two — and both ends are brought up onto the abdomen, positioned side by side. This can involve:
- Two ends of large bowel (a double barrelled colostomy)
- The end of the small bowel and an end of the large bowel (a double barrelled ileostomy/colostomy)
- Two ends of small bowel (a double barrelled ileostomy)
Note that this is only a general article, and that stoma care nurse will be able to explain exactly what type of stoma you have and what function to expect from it.
Double barrel stoma vs loop stoma: What's the difference?
One of the most common questions people ask is about the difference between a double barrel and a loop stoma, since both can look similar at first sight.
- With a loop stoma, the bowel isn't fully divided. A loop of bowel is simply brought up onto the surface of the abdomen, usually to divert stool away from a healing join (anastomosis) or a diseased section further down, allowing that area to heal.
- With a double barrel stoma, the bowel is completely separated into two distinct ends, both brought out onto the abdomen. The proximal (nearest) stoma is the functioning end, still connected to the gastrointestinal tract, and this is the one that drains stool. The distal stoma is connected to the rectum and is known as a mucus fistula, as it only drains small amounts of mucus.
In short, a loop stoma keeps the bowel intact but diverted; while a double barrel stoma involves two fully separate openings. This distinction is also why a double barrel stoma will often look slightly bigger than other stomas, and can sit a little higher on the abdomen.
Double barrelled transverse colostomy
A double barrel stoma is most commonly created as a transverse colostomy, formed in the upper part of the abdomen, either centrally or towards the right side of the body. This is usually used for conditions such as inflammatory bowel disease, diverticulitis, cancer, obstruction, injury, or birth defects, giving the lower colon time to rest and heal.
In some cases, instead of creating two visible stomas, the inactive end of the bowel is closed and left inside the abdomen instead of being brought to the surface. When this happens, there's only one visible stoma, referred to as a single-barrelled stoma, with any mucus from the resting portion of bowel passing out through the anus as usual.
Double barrel stoma indications
A double barrel stoma may be recommended for a number of reasons, including:
- Resection of the large bowel due to perforation or necrosis
- Temporary diversion while an area of bowel heals
- Cancer-related surgery, where the colon and rectum need time to heal following treatment
- Situations where the bowel needs to be fully rested rather than simply diverted
As it's often used to give the bowel a period of rest, a double barrel stoma is often temporary rather than permanent.
What does a double barrel stoma look like?
A double barrel stoma looks broadly similar to other colostomies, but tends to be slightly larger, since more bowel is involved and two ends are visible on the abdomen rather than one. It's also usually positioned a little higher up than most other stomas.
What appliance is needed for a double barrel stoma?
Because the output from this type of stoma is typically semi-solid, a drainable appliance is often easier to manage, as it reduces how often the skin around the stoma needs to be disturbed for emptying. It's worth keeping an eye on the surrounding skin for any soreness caused by effluent sitting against it, and making sure the template fits well to support good stoma health.
For more general information about the topic of stoma and peristomal skin, feel free to refer to our respective articles:
Double barrel stoma reversal
Because a double barrel stoma is often created to rest an area of the bowel, it's commonly reversed once healing is complete. Reversal involves reconnecting the two ends of bowel in a further surgery, restoring normal bowel continuity where possible. Timelines vary depending on the underlying condition and healing process — this can range from a few weeks to several months, and in some cases longer.
FAQ: Double barrel stomas
What is a double barrel stoma?
A double barrel stoma is created when the bowel is fully separated into two ends, both brought out onto the abdomen — one functioning end that drains stool, and one resting end (a mucus fistula) that drains small amounts of mucus.
What's the difference between a double barrel and a loop stoma?
A loop stoma keeps the bowel intact but diverted through a single opening, while a double barrel stoma fully separates the bowel into two distinct stomas.
Is a double barrel stoma permanent?
Not usually. It's most often used as a temporary measure to rest part of the bowel, with reversal surgery possible once healing is complete — though this depends on the individual's underlying condition.
What appliance is best for a double barrel stoma?
A drainable appliance is generally recommended, as the output tends to be semi-solid and drainable pouches reduce how often the surrounding skin is disturbed.