Parastomal evisceration as an extremely rare complication of a common procedure

Abstract

The creation of an abdominal stoma is a common procedure performed as part of the treatment for many conditions. Common complications include poor stoma siting, high output, skin irritation, ischaemia, retraction, parastomal hernia and prolapse. An extremely rare stoma complication is parastomal evisceration. We present a case of a 48-year-old woman who presented to us with parastomal evisceration as a late complication of a transverse colostomy. It is the second case reported as a complication of this procedure but the first that occurred after such a long postoperative period (almost 18 months). The creation of a permanent or temporary stoma is a common procedure performed as part of the treatment of many conditions. It has a 6-59% complication rate. Common complications include poor stoma siting, high output, skin irritation, ischaemia, retraction, stenosis and prolapse. 1 An extremely rare stoma complication is parastomal evisceration, with only seven cases reported in the literature. 2-8This is the evisceration of abdominal viscera through a pre-existing stoma, either in the immediate postoperative period owing to suture line disruption or later as a result of ostomy wall necrosis. We report a case of a 48-year-old female patient who presented with parastomal evisceration 18 months after the creation of a transverse colostomy. Case historyA 48-year-old woman presented to our surgical department with a parastomal hernia, significant colostomy prolapse, partial colostomy necrosis, and evisceration of small bowel and omentum through the colostomy (Fig 1). The colostomy was an end colostomy at the transverse colon, which had been created laparoscopically 18 months previously, when the patient was diagnosed with stage IV rectal cancer (liver and ovarian metastasis) and a rectovaginal fistula. She was diagnosed initially as having ovarian tumours, which were resected, and the histopathology report revealed an adenocarcinoma of colorectal origin. She received chemotherapy (folinic acid, fluorouracil, oxaliplatin and bevacizumab), to which there was significant response, but following the chemotherapy, she developed severe pulmonary fibrosis, which was treated with high dose cortisone. Her past medical history included posttraumatic cardiac dysrhythmias and a pacemaker had been implanted for that reason. Visceral reduction and colostomy reversal was performed, followed by a right hemicolectomy. Given the excellent response to chemotherapy, the small pelvis was explored, in an attempt to resect the uterus en bloc with the rectum so as to restore bowel continuity without any stoma but that was not feasible. Instead, a class II hysterectomy was performed owing to a palpable diffuse hardness of the uterus. Intestinal continuity was restored with a side-to-side ileotransverse anastomosis. A loop colostomy was created at the sigmoid colon. The abdominal wall was reconstructed with primary closure. The whole procedure was carried out under combined epidural and spinal anaesthesia with intravenous sedation (remifen...

Spontaneous rupture of a parastomal hernia with evisceration of small bowel: a case report

“…due to COPD) may have also contributed. Lolis et al [7] reported a patient with similar contributory factors in a patient with a parastomal hernia and a chronic colostomy prolapse.…”

“…Parastomal evisceration is a very rare complication of stomas and to date, only ten cases have been reported worldwide. Most of the previously published cases were associated with ileostomies [4][5][6] and four were reported in association with colostomies [7][8][9][10].The majority of the cases were associated with stoma prolapse or parastomal hernia and one within the immediate post-operative period [10].…”

Paracolostomy Evisceration: Short Review and a New Case Report

“…The most frequent indication for colostomy was rectal cancer (1,3,13); the indication for colostomy was extensive hidradenitis suppurativa of the perineum in another case-report (5). Evisceration occured within a time span of 5 (5) to 18 months (13).…”

“…For the purpose of our study we excluded ileostomy-related parastomal eviscerations and focused on conditions related to colostomy evisceration. We reviewed four articles concerning 4 case reports of late evisceration (1,3,5,13) and three articles on 4 case reports (4,6,7) presenting early postoperative para-stomal evisceration after colostomy (within one month after creation of the colostomy). All case reports were published since 2011.…”

“…The most frequent indication for colostomy was rectal cancer (1,3,13); the indication for colostomy was extensive hidradenitis suppurativa of the perineum in another case-report (5). Evisceration occured within a time span of 5 (5) to 18 months (13). Anatomical site and fashion of colostomy were irelevant, since the complication was associated to: transverse loop (3) or end (13) colostomy, as well as to loop sigmoid colostomy (5) or end descending colostomy (1).…”