Gastric Parastomal Hernia: A Case Report of a Rare yet Fascinating Clinical Entity

Abstract

A 58-year-old female with the prior history of diabetes mellitus (DM) presented with nausea, malaise, and abdominal pain of two days duration. Also, in the past, she was treated for a necrotized rectum from a retroperitoneal infection leading to a colostomy in the left lower quadrant (LLQ) of the abdomen. The physical examination findings were highly suggestive for a parastomal hernia. As a part of her workup and treatment, the initial abdominal CT demonstrated the presence of the gastric contents into the hernia sac leading to the gastric obstruction. The patient responded well to the conservative management using nasogastric (NG) suction, intravenous (IV) line maintenance, clinical assessment, frequent vital sign monitoring, and initiating the nothing per oral (NPO) regimen. Following the successful conservative approach, the patient opted to undergo surgical treatment in the future. This case report and associated literature search represent a rare case of a parastomal hernia with protruding gastric contents, which was successfully treated with conservative management.

Incomplete Gastric Obstruction Due to Herniation of Stomach Into Parastomal Hernia: A Case Report

“…The European Hernia Society suggested the placement of a prophylactic mesh simultaneous to the creation of stoma to prevent the formation of parastomal hernia [ 2 ]. In this case, we followed a conservative plan of treatment in the patient like in another case of gastric parastomal hernia described by Waheed et al [ 12 ]. We agree with the statement of the European Hernia Society that in patients with a parastomal hernia, the application of a hernia support belt may be useful in terms of reducing the risk of complications [ 2 ].…”

A Case of Gastric Outlet Obstruction Secondary to Parastomal Stomach Herniation

“…Although there have been recent advancements in surgical practices and techniques, the incidence of parastomal hernia (PH), along with its complications, has been on the rise [ 1 ]. A parastomal hernia (PH) is an abnormal herniation of tissue or an intrabdominal organ through the fascial defect formed at an ostomy site, with the highest incidence after end colostomy at a rate of 4-48.1% [ 2 , 3 ]. The herniation is due to the continuous stretching of the abdominal wall by any force applied to the circumference of the ostomy [ 4 ].…”

“…Stomach herniation in the parastomal sac is very uncommon and is used as an important and unusual differential diagnosis of gastric outlet obstruction [ 2 , 6 ]. A gastric parastomal hernia (GPH) may lead to symptoms of gastric outlet obstruction and, if incarcerated, can become a surgical emergency [ 3 - 5 ]. Diagnosis is made with the help of a computerized tomography (CT) scan of the abdomen and upper endoscopy to rule out pyloric obstruction [ 3 ].…”

“…A gastric parastomal hernia (GPH) may lead to symptoms of gastric outlet obstruction and, if incarcerated, can become a surgical emergency [ 3 - 5 ]. Diagnosis is made with the help of a computerized tomography (CT) scan of the abdomen and upper endoscopy to rule out pyloric obstruction [ 3 ]. Management is initially conservative and is followed by surgery to correct the defect [ 3 ].…”

“…Diagnosis is made with the help of a computerized tomography (CT) scan of the abdomen and upper endoscopy to rule out pyloric obstruction [ 3 ]. Management is initially conservative and is followed by surgery to correct the defect [ 3 ]. Here, we present a case of an 83-year-old female who presented with a clinical picture of gastric outlet obstruction and was subsequently diagnosed with a gastric parastomal hernia.…”