Late parastomal evisceration: A case report of a rare complication following loop ileostomy for an obstructing rectal cancer

Izwan, Sara; Perera, Omattage Mahasha; Guy, Stephen J.

doi:10.1016/j.ijscr.2023.107936

Cited by 1 publication

(9 citation statements)

References 19 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Cause Of Eviscerationmentioning

confidence: 99%

“…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%).…”

Section: Surgical Stoma Treatmentmentioning

confidence: 99%

“…Iswan et al [ 37 ], 2023, reported a 50-year-old male with loop ileostomy (for obstructing rectal ADK), complicated three months later by parastomal hernia containing SB (managed non-operatively in the context of neoadjuvant therapy). Rupture of the neglected parastomal hernia was, probably, the cause of the late (seven months after surgery) parastomal evisceration.…”

Section: Reviewmentioning

confidence: 99%

“…Malignancy (16/28, 57.14%) was not demonstrated as a predisposing factor. Rectal ADK (12/16, 75%) was the main indication of malignancy, but in most instances, evisceration was not related to the malignant condition itself but to the temporary diversion: ileostomy [ 13 , 37 ] or transversostomy [ 17 , 18 , 23 , 24 ].…”

Section: Reviewmentioning

confidence: 99%

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

Mateș

2024

Cureus

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Evisceration is an exceptional complication of diverting a stoma (a common procedure, often considered a minor surgery) with peculiar, specific, features (distinct-to-usual incisional evisceration), due to the presence of a stoma. Available data are limited to a few case reports; some aspects are not fully documented. The results of 28 case reports (full-text articles published in the English literature) were analyzed using 14 variables: age and gender; pathology; surgical setting; index surgery and type of stoma; intended stoma creation; time from surgery to evisceration; type of evisceration; visceral content; cause of evisceration; specific predisposing/risk factors; surgical approach; resection of nonviable content; surgical stoma treatment; and short-term outcome. Urgent surgery resulted in 46.42% resection of nonviable eviscerated content and 7.14% mortality.All issues (some not discussed in previous reviews) were analyzed, to highlight their clinical relevance for surgical practice. The mechanisms (types of evisceration) are different in parastomal and transstomal/intrastomal evisceration; they should be considered as distinct entities. The real (underlying) etiology was identified in 26/28 case reports (92.85%): surgical failure, such as inadequate technique/tactics/strategy (12/26 case reports, 46.15%); trauma (7/26 case reports, 26.92%); and spontaneous necrosis (6/26 case reports, 21.42%). Parastomal hernia and/or prolapse (10/28 case reports, 35.71%) were specific predisposing factors; in such cases, early surgical treatment is recommended.Temporary stoma was a potential risk factor, both for early as well as for late evisceration (e.g., longstanding temporary stoma); in such cases, early take-down or conversion to definitive stoma is beneficial. A local surgical approach (avoiding median laparotomy) was used in 13/28 (46.42%) of case reports. Seven different surgical options were used for surgical stoma treatment, demonstrating versatility; the initial stoma site was preserved in 22/28 (78.57%) of case reports.

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