Case report and operative management of gallbladder herniation

Abstract

BackgroundIncarcerated abdominal wall hernias may contain a variety of contents, but very rarely contains the gallbladder. This rare diagnosis is often not considered and, when diagnosed, has a different management approach. The experience of the small number of case reports have yet to be collected and summarised.Case presentationWe report a presentation and management of an 85 year old Caucasian female with a gallbladder hernia into a parastomal defect, and outline the operative management.ConclusionIncarcerated gallbladder hernia is an extremely unusual condition, best diagnosed by CT scan. Management should involve operative reduction, cholecystectomy and consideration of repair of the defect.

Parastomal Hernia with Incarcerated Gallbladder: A Case Report

“…Herniation and incarceration of the gallbladder in a parastomal hernia is an uncommon event and few cases have been reported in the literature [2,[5][6][7]. A recent case report identified patterns of presentation and management.…”

“…An incarcerated gallbladder hernia is a rare condition, and a small number of case reports describe wall reconstruction with bioprosthetic mesh reduces recurrence of herniation at the midline incisional hernia site and the trephination. Cholecystectomy and abdominal wall reconstruction has been described similarly on case reports [5].…”

Parastomal gallbladder hernia in a septic patient

“…Risk factors for developing parastomal hernia development include advanced age, high body mass index, smoking, and presence of colostomy rather than ileostomy [3] , [4] . Gallbladder herniation at any site is rare, and only a few cases have been reported in the literature [5] . Among the 6 previously reported cases of parastomal gallbladder herniation, the majority presented with progressive abdominal pain and preserved bowel function [4] , [5] , [6] , [7] , [8] , [9] .…”

“…Gallbladder herniation at any site is rare, and only a few cases have been reported in the literature [5] . Among the 6 previously reported cases of parastomal gallbladder herniation, the majority presented with progressive abdominal pain and preserved bowel function [4] , [5] , [6] , [7] , [8] , [9] . The only reported case managed without urgent cholecystectomy was treated conservatively because of patient's advanced age, cardiovascular disease, and patient preference [4] .…”

How to apply clinical cases and medical literature in the framework of a modified “failure mode and effects analysis” as a clinical reasoning tool – an illustration using the human biliary system

“…Perforation – other causes can be Epstein–Barr virus [10], liver abscess [11], blunt abdominal trauma [12], and spontaneous [13]Bile leaked into the peritoneum [9]Umbilical pain and a bluish discoloration of the skin around a known umbilical hernia presumably due to tracking of bile within the abdomen [9]Liver function test, laparotomy [9]The patient had spontaneous acalculous gallbladder perforation [9]. This condition is rare but criticalGallbladder herniation: parastomal [14–18], incisional [19–21], spontaneous ventral [22, 23], epigastric [24], transdiaphragmatic herniation [25]A midline abdominal hernia with small bowel loops, and a parastomal hernia containing the gallbladder [14]Abdominal pain [14]CT scan with oral Gastrograffin (sodium diatrizoate and meglumine diatrizoate) contrast [14]Gallbladder torsion [17]Torsion of the neck of the gallbladder with secondary suppuration leading to gangrenous changes in the gallbladder [17]Abdominal pain [17]Abdominal CT [17]Other case of gallbladder torsion [26], a new case of gallbladder torsion within an incisional hernia [27], complete gallbladder torsion [28], gallbladder torsion caused acute cholecystitis [7]A gallstone enters via the Vater papilla and later increases in size [29]Transition of a gallstone in the gastrointestinal tract leading to mechanical bowel obstruction (gallstone ileus) [29]Nausea, vomiting and abdominal pain [29]Abdominal CT, MRCP [29]Other case: gallbladder-colon fistula [30] and cholecystogastric fistula [31]Biliary-enteric fistula e.g. gallbladder-duodenal fistula [8]“Spontaneous biliary fistulas have been associated with gallbladder cancer; if they are the cause of cancer, or acomplication of it, this has not yet been defined.” [8]1-month history of episodic nausea and vomiting, and epigastric pain on admission [8]Abdominal ultrasound, CT, barium study [8]Failure of the cystic bud to develop in utero [32]Gallbladder...…”