Parastomal Small Bowel Evisceration as a Result of Parastomal Pyoderma Gangrenosum in a Patient with Crohn's Disease

Vornehm, Nicholas D.; Kelley, Scott R.; Ellis, Bryan

doi:10.1177/000313481107700709

Cited by 11 publications

(5 citation statements)

References 2 publications

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“…Table 1 [ [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] summarizes the 17 cases of parastomal and transstomal evisceration. Of the 17 cases identified from the literature review, 14 (82%) were male with a median age of 62 years.…”

Section: Discussionmentioning

confidence: 99%

Colonic Perforation and Transstomal Evisceration of Small Bowel

et al. 2021

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The formation of an abdominal stoma is a commonly performed procedure in gastrointestinal surgery. Common complications include parastomal hernia, stomal necrosis, stomal prolapse, stenosis and secondary effects to surrounding skin. Transstomal evisceration is an extremely rare complication with only two previous reported cases. We present a unique case of transstomal evisceration of small bowel secondary to blunt force trauma. In addition, parastomal evisceration is also uncommon with only 15 reported cases. These conditions require emergent operative intervention due to the risk of ischemic injury to eviscerated contents.

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Section: Discussionmentioning

confidence: 99%

Colonic Perforation and Transstomal Evisceration of Small Bowel

et al. 2021

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“…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%

“…Vornehm et al [ 16 ], 2011, reported a late (two years after surgery) SB parastomal evisceration in a 66-year-old female with a long history of Crohn’s disease after Hartmann’s procedure for perforated diverticulitis. Extensive chronic parastomal pyoderma gangrenosum created a large fascial defect.…”

Section: Reviewmentioning

confidence: 99%

“…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.…”

Section: Reviewmentioning

confidence: 99%

“…The presence of stoma permitted three different types. First: laparotomy (53.57%), especially for late [ 13 , 15 , 16 , 18 , 19 , 23 , 26 , 29 , 31 , 34 - 36 ] rather than for early evisceration [ 20 , 25 , 30 ]. Second: parastomal approach (42.85%), especially for early [ 12 , 17 , 22 , 24 , 27 , 28 , 32 , 37 , 38 ] rather than for late evisceration [ 21 , 33 ].…”

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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