Parastomal Gallbladder Herniation as an Incidental Preoperative Computed Tomography Finding

Abstract

A 65-year-old woman with a long surgical history was referred to our hospital’s Colorectal Unit for ileostomy management. The patient retained an ileostomy for almost a decade after a series of complicated operations she had undergone, which had several side effects such as electrolyte imbalances, high output, weight loss, and a parastomal hernia. Our hospital’s colorectal surgeon proposed to replace the ileostomy with a permanent sigmoidostomy and asked for an imaging evaluation of the parastomal hernia content before the surgery. A computed tomography of the abdomen was performed using our Computed Tomography Department’s 64-detector row CT scanner after oral administration of contrast media, without intravenous contrast media injection due to allergy. Concerning the parastomal ileostomal hernia, besides small bowel loops with intraluminal gastrografin, inside the parastomal hernial sac, there also was an almost rounded cystic lesion. Absence of the gallbladder at its typical position and no record of cholecystectomy raised suspicion for gallbladder projection inside the sac. Our suspicion was confirmed during the surgery. Nonexisting acute cholecystitis allowed easy reduction of the gallbladder along with the small bowel loops inside the peritoneal cavity, without proceeding to cholecystectomy at the same time. Finally, ileostomy was annulated and an end colostomy was established. Four days after the surgery, the patient was discharged from the hospital and was happy to live an almost normal life thereafter.

A Case of Perforated Cholecystitis into a Parastomal Hernia

“…One case decompressed the gallbladder intraoperatively with a 14-gauge needle for source control of the intraluminal infection and to facilitate with reduction of the hernia [ 5 ]. For noninflamed gallbladder herniation, the hernia may be reduced and repaired without cholecystectomy [ 11 , 12 ].…”

A rare case of parastomal hernia complicated by gallbladder incarceration

“…Usually PSH contains a segment of omentum, small bowel, or colon. The herniation of gallbladder in PSH is an extremely rare condition and has been reported 10 times previously 1–10 . The aim of this report is to present a rare case of a gallbladder parastomal herniation with successful manual reduction and resolution of symptoms.…”

“…Seven cases were managed with surgical intervention with gallbladder sparing procedure in two cases 3,6 . The PSH was repaired in four cases 1,2,3,6 and only cholecystectomy without hernia repair was performed in three cases 5,7,10 . In all previously reported cases but two 1,8 where PSH complicated colostomy, the gallbladder herniation was a complication of ileostomy or ileal uroconduit 5,10 which is due to the fact that colostomy is much less commonly formed on the right‐hand site.…”

“…In previously reported cases three out of 10 cases 4,8,9 were managed successfully with conservative measures due to patient being unfit for surgical intervention as in our case. Seven cases were managed with surgical intervention with gallbladder sparing procedure in two cases 3,6 . The PSH was repaired in four cases 1,2,3,6 and only cholecystectomy without hernia repair was performed in three cases 5,7,10 .…”

Spontaneous Resolution of Parastomal Gallbladder Herniation After Attempted Surgical Intervention: A Case Report and Review of the Literature

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. Including our case, the mean age of cholecystic parastomal herniation presentation is 72.8 years of age with a female predominance of 88%.…”