Internal hernia of the stomach through the lateral space of the colostomy: a case report

Abstract

An 81-year-old woman had undergone laparoscopic abdominoperineal resection for rectal cancer. A permanent colostomy was created through an intraperitoneal route. Three months after the surgery, the patient presented with lower abdominal pain and vomiting. Computed tomography showed gastric incarceration through the lateral space of the lifted sigmoid colostomy. Although the herniated stomach was reduced by nasogastric tube decompression, the patient experienced a recurrence of gastric hernia shortly thereafter. A laparoscopic operation was performed, and a new colostomy was constructed through an extraperitoneal route. The patient had no hernia recurrence during the 20 months of follow-up after the operation. Gastric internal hernia associated with colostomy can occur as a rare complication. Although reduction of the incarcerated stomach is possible by nasogastric tube decompression, surgical repair of the hernia may be the optimal management to prevent recurrence.

Post-colostomy internal hernia of the stomach treated with laparoscopic gastropexy: a case report

“…Mesenteric defects often lead to intestinal obstruction and rarely to internal hernias of the stomach. Two cases of internal hernias of the stomach following a sigmoid colostomy have been reported; one was treated by suturing the sigmoid stoma to the abdominal wall [ 3 ], while the other was treated by changing the intraperitoneal route to an extraperitoneal one [ 4 ]. In both cases, an abdominoperineal resection was performed and an end stoma was created.…”

“…Two previous cases reported that a reliable treatment for hernia was to close the aperture surgically [ 3 , 4 ]. It was thought best to perform abdominoperineal resection and the aperture closure surgery at the same time, however, since the patient was undergoing chemoradiation therapy and it was difficult to change the date of lengthy surgery, we decided to perform them separately.…”

“…Internal hernias are most commonly associated with the small intestine and are rarely associated with the stomach. Internal hernias of the stomach comprise parastomal hernias [ 2 ] and post-colostomy internal hernias [ 3 , 4 ]. The stomach dilates after eating and descends into the pelvis through the space between the lifted sigmoid colon and the left abdominal wall.…”

“…Notably, only two cases of post-colostomy internal hernias have been reported. The first case was treated by suturing the sigmoid colon to the lateral abdominal wall [ 3 ], while the second case was treated by changing the intraperitoneal route to an extraperitoneal one [ 4 ]. Both treatments are for closing an aperture, and the use of gastropexy for treatment has not been reported yet.…”