A Case of Gastric Outlet Obstruction Secondary to Parastomal Stomach Herniation

Abstract

Parastomal hernia (PH) is an abnormal herniation of tissue or intra-abdominal organ through the fascial defect created at the ostomy site. It is a common complication of stoma creation and usually contains bowel, intra-abdominal fat, or omentum. Herniation of a fixed organ like the stomach is very rare and can lead to significant morbidity and mortality. Here, we present a case of an 83-year-old female with a history of sigmoidectomy and subsequent development of parastomal hernia who presented with abdominal pain, nausea, and vomiting and was found to have stomach herniation into the parastomal hernia sac. She was managed conservatively with intravenous (IV) fluids, electrolyte replacement, and decompression with a nasogastric (NG) tube. In this article, we have discussed the incidence, clinical presentation, diagnosis, and management of gastric involvement in the parastomal hernia that can help clinicians identify and treat it early at the time of presentation.

Insidious Onset of Incarcerated Parastomal Hernia With Gastric Outlet Obstruction: A Case Report

“…Additional factors which increase the risk of parastomal herniation include increasing age, obesity, infection, smoking, and chronic obstructive pulmonary disease. In this patient, there was a strong history of tobacco abuse, prior diagnosis of COPD, female sex, and formation of an end colostomy [ 3 ]. These factors increase the combined risk of developing a PH, and thereby a gastric PH.…”

“…Herniation of the stomach is an uncommon finding through parastomal herniae and can lead to symptoms representing gastric outlet obstruction [ 2 ]. A gastric hernia can subsequently become incarcerated or strangulated representing a surgical emergency [ 3 ].…”