Colostomy orifice complications: a case report of a prolapsed colostomy with necrosis of the eviscerated greater omentum

Abstract

Evisceration and necrosis of the greater omentum at the site of a prolapsed colostomy is a rare situation. Considered an early stoma complication, it often occurs during the first month after surgery. We report the observation and our attitude to such a situation in a 56-year-old patient who underwent initial surgery for a locally advanced rectal adenocarcinoma after receiving neoadjuvant radio-chemotherapy. A loop colostomy for decompression was performed due to large bowel obstruction. On the 10th day after surgery, he was readmitted for an oedematous prolapsed colostomy and a necrotic end of the greater omentum, which eviscerated through the colostomic hole, secondary to severe ascites. Emergency re-intervention involving resection of the prolapsed stoma with the necrotic segment of the omentum was performed. The three factors associated with the development of this rare peri-colostomy complication were: emergency surgery, locally advanced rectal tumor, and increased intra-abdominal pressure.

Diverting Stoma-Related Evisceration: A Comprehensive Review of 28 Case Reports Published in the Medical Literature in English

“…Seven different options were used for surgical stoma treatment, demonstrating a high versatility: stoma revision/refashion [20][21][22]24,25,27,28,30,37]; partial resection and recreation of initial stoma [19,29,[31][32][33]; repair of tansstomal defect [14,18,34,35]; repositioning to a new site [15,16,23,36]; conversion to another type of stoma in the same location [12,17]; take-down of temporary ileostomy [13]; and stoma resection [23]. The initial stoma site was preserved in 22/28 case reports (78.57%).…”

“…Rockson et al [ 32 ], 2021, published the case of a 56-year-old male who underwent surgery for a locally advanced rectal ADK after receiving total neoadjuvant therapy. Loop sigmoidostomy was practiced for CLBO decompression; ~5 liters of the ascitic liquid were suctioned during index surgery without placing intra-abdominal drains.…”

“…Similar to usual stoma complications, evisceration was defined as early (within 30 days after surgery) or late (after that interval). Early eviscerations (2-12 days, mean 7.16 days) were reported in 12/28 (42.85%) case reports, mainly associated with temporary stomas [ 12 , 17 , 20 , 24 , 27 , 28 , 30 , 32 ]. The risk accumulates in time so that most (16/28, 57.14%) were late eviscerations (2-84 months, mean 18 months; interval not reported in two case reports), including long-standing temporary stomas [ 13 , 18 , 26 , 29 , 37 ].…”

“…Parastomal and transstomal eviscerations are distinct entities as far as the site of evisceration in relation to the exteriorized viscus, time from surgery, and surgical stoma treatment are concerned. Parastomal evisceration (20/28, 71.42%) appeared alongside the viscus, both in early [ 12 , 17 , 20 , 22 , 24 , 25 , 27 , 28 , 30 , 32 , 38 ] and late eviscerations [ 13 , 15 , 16 , 21 , 26 , 33 , 36 , 37 ]. Transstomal/intrastromal evisceration (8/28, 28.57%) was always a late one (range: three months to seven years, mean 26.43 months), as the result of a condition that perforates the stoma wall permitting evisceration within its lumen.…”

“…The eviscerated content varied according to each case report and it was not connected to the type of stoma or mechanism of evisceration: SB (24/28; 85.71%), TC [ 17 , 27 ], SC [ 33 ], LO alongside a hollow viscus [ 23 , 27 , 33 ], or only LO [ 14 , 32 ].…”