An extremely rare complication of intestinal stoma formation: parastomal evisceration 1-year post-loop ileostomy

Abstract

Intestinal stoma formation is an important and frequently performed procedure in emergency and elective general surgery. Parastomal evisceration is an extremely rare complication of stoma formation. The literature to date consists of a small number of case reports only. We report the case of a 54-year-old patient who presented 1-year post-loop ileostomy formation with a large parastomal evisceration. This was managed with emergency laparotomy. Our case highlights the high morbidity of this rare complication and the importance of emergent management and patient’s education.

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

“…Previous reviews [27,28,30,31,[36][37][38] included fewer case reports and variables. Issues related to the topic (some not discussed before) are described and analyzed to highlight their clinical relevance for surgical practice.…”

“…Knowledge of etiology is paramount for prevention. Previous studies [13,14,[17][18][19][20][21][22][23][24][25]27,28,30,[36][37][38] focused on alleged predisposing risk factors: COPD, cough in the postoperative period; increased intra-abdominal pressure; chronic alcohol abuse, smoking; emergency surgery; advanced age; disseminated cancer, ascites; poor nutrition; immunosuppressive therapy, HIV; and diabetes mellitus. Risk factors (e.g., comorbidities) are associated with any incisional evisceration and are not specific to stoma evisceration; they can not be responsible if a direct, specific, cause is identified.…”

“…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%).…”

“…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.…”

“…Murphy et al[36], 2023, reported a 54-year-old male presenting with a large parastomal evisceration containing >100 cm of strangulated, non-viable SB. A loop ileostomy was formed one year prior at the time of an elective ileocecectomy for Crohn's disease.…”