Parastomal gallbladder hernia in a septic patient

Abstract

Parastomal gallbladder herniation is a rare complication of enterostomies with only 6 previously reported cases. Most cases have occurred in elderly women. Patients typically presented with acute abdominal pain and the majority was managed operatively. Here, we report the clinical course of an 88-year-old female who presented with signs of sepsis and minimal abdominal symptoms. She was subsequently found to have a parastomal gallbladder herniation and Klebsiella pneumoniae bacteremia. Given the patient's multiple comorbidities, she was managed nonoperatively with manual reduction of the parastomal hernia and antibiotics.

Gallbladder complicating a parastomal hernia

“…According to the literature, there are only seven other reported cases. There is a predominance for the elderly, with the average patient age of these seven cases being 75.4 years of age and all but two cases being female [1–7]. Suggested factors for occurrence in the elderly are elastic tissue, reduced intra-abdominal fat, liver shrinkage and increased gallbladder mesentery [8].…”

“…In the majority of cases, the gallbladder was incarcerated or showed signs of cholecystitis within in the hernia, requiring emergent intervention with cholecystectomy. In those patients with signs of cholecystitis who had significant co-morbidities or refused further surgery, conservative management was undertaken [1–7]. See Fig.…”

Acute cholecystitis in a parastomal hernia causing a small bowel obstruction

“…She was found to have a chronically inflamed, distended and thickened gallbladder in her parastomal hernia. The hernia was manually reduced and patient was discharged without a cholecystectomy because she was a poor surgical candidate [ 2 ]. The second case was an 85-year-old woman status post cystectomy for urothelial carcinoma with an ileal conduit who presented with fevers and abdominal pain.…”

Parastomal gallbladder herniation: A case report and review of the literature

“…One additional manuscript was identified through bibliographic analysis. In total, we identified eight other cases of parastomal gallbladder herniation ( Table 1 ) [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] ]. The average age of the previously described cases is 77 years with 75% of patients being female.…”

“…Of the previously described cases, three were successfully treated conservatively despite an initially symptomatic presentation [ 9 , 10 , 13 ]. Even though in all three patients conservative management was attempted because of significant comorbidities, their favorable outcome indicates that a conservative approach may be valid if the gallbladder is not incarcerated and the patient is hemodynamically stable at presentation [ 3 ].…”