Early parastomal evisceration of small bowel following a loop ileostomy for malignant intestinal obstruction

Abstract

Evisceration of bowel through the stoma is a rare complication and only few cases have been reported. Although most cases occur in the context of long-standing parastomal hernias, early evisceration may also occur causing significant morbidity to patients. The reported patient is a 53-year-old male with bronchial asthma who was diagnosed to have metastatic colonic cancer underwent a trephine loop ileostomy for intestinal obstruction. On post-operative Day 7, he developed small bowel evisceration through the ileostomy site. The patient underwent an emergency laparotomy and found to have non-viable prolapsed small bowel segment at the stoma site. Furthermore, there were extensive peritoneal deposits and large para aortic lymph node mass and ascites compromising the peritoneal space. Resection of non-viable small bowel and ileostomy refashioning was carried out. The patient was managed in the intensive care unit and he gained function of the ileostomy on post-operative Day 2. On Day 5, he died due to subsequent pneumonia and worsening acute respiratory distress syndrome. Early parastomal evisceration is an extremely infrequent life-threatening complication that requires urgent treatment. Disseminated cancer, bowel obstruction, poor nutritional status, ascites and exacerbation of bronchial asthma were additional risk factors in our patient.

Adenocarcinoma-Induced Sigmoid Colon Intussusception and Postoperative Parastomal Evisceration in an Elderly Patient: A Case Report and Literature Review

“…In the previously published cases, several risk factors were reported. Emergency surgery, old age, postoperative cough, chronic obstructive pulmonary disease (COPD), and elevated intra-abdominal pressure were all reported as predisposing factors in most case reports [ 21 ].…”

Late parastomal evisceration: A case report of a rare complication following loop ileostomy for an obstructing rectal cancer

“…The creation of a permanent or temporary stoma is a common procedure performed with a complication rate of between 20 and 70 % [4] , [6] , [7] . Common complications associated with stomas may range from minor complications such as peristomal excoriation and cellulitis, to major complications such as parastomal herniation [1] , [8] .…”

“…The evisceration of abdominal contents adjacent to (parastomal) or through (transstomal) a pre-existing stoma, is a rare complication, with only 16 cases reported in the literature. The majority of reported cases describe evisceration within a few days of index surgery [6] , [7] , [9] , [10] , [11] , [12] , [13] however there have also been cases where evisceration has occurred up to 12 to 18 months following a stoma [4] , [14] , [20] . Evisceration has been demonstrated in both ileostomy [6] , [7] , [9] , [11] , [15] , [16] , [17] and colostomy [4] , [9] , [10] , [12] , [13] , [14] , [18] , [19] , [20] .…”

“…The majority of reported cases describe evisceration within a few days of index surgery [6] , [7] , [9] , [10] , [11] , [12] , [13] however there have also been cases where evisceration has occurred up to 12 to 18 months following a stoma [4] , [14] , [20] . Evisceration has been demonstrated in both ileostomy [6] , [7] , [9] , [11] , [15] , [16] , [17] and colostomy [4] , [9] , [10] , [12] , [13] , [14] , [18] , [19] , [20] . These cases are summarised in Table 1 .…”

“…Early complications are considered complications that occur within 30 days of surgery, and late complications considered those present after 30 days [3] . A rare and very unusual complication of a stoma is evisceration of bowel contents, which may occur either via parastomal [1] , [2] , [3] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] or transstomal [4] , [18] , [19] , [20] evisceration. In the majority of such cases, evisceration occurred in the early postoperative period however, there have been reports of this complication up to 18 months post index surgery [4] .…”