Background/Aim: The purpose of this article was to report an adapted colostomy procedure that can be used on patients with multiple morbidities requiring fecal diversion. Methods: An adapted colostomy was performed on a patient needing fecal diversion who had multiple surgical and medical complications. Results: Thirteen weeks after colostomy placement, the patient’s colostomy functioned well and was viable throughout his course without related complications. Conclusion: The method of sigmoidoscopy-assisted colostomy described here can be beneficial to the complicated patient needing fecal diversion but unable to tolerate a laparotomy or laparoscopy.