Izwan Sara, Perera Omattage Mahasha, Guy Stephen
Department of General Surgery, Gold Coast University Hospital, Southport, QLD 4215, Australia; School of Medicine and Dentistry, Griffith University, Southport, QLD 4215, Australia.
Department of General Surgery, Gold Coast University Hospital, Southport, QLD 4215, Australia.
Int J Surg Case Rep. 2023 Apr;105:107936. doi: 10.1016/j.ijscr.2023.107936. Epub 2023 Feb 18.
Parastomal evisceration is a very uncommon complication of a stoma, with only a few cases currently published in the literature. It may occur either early or late following either ileostomy or colostomy and has been reported in both the emergency and elective setting. The aetiology is likely multifactorial, but a few risk factors have been identified that predispose to its occurrence. Early recognition and prompt surgical evaluation is necessary, and management depends on patient, pathologic and environmental factors.
A 50-year-old man with an obstructing rectal cancer underwent elective surgery for the creation of a temporary loop ileostomy prior to commencement of neoadjuvant chemotherapy (capecitabine and oxaliplatin). His background included obesity, alcohol excess and he was a current smoker. His postoperative course was complicated by a non-obstructing parastomal hernia which was managed non-operatively in the context of his neoadjuvant therapy. Seven months after his loop ileostomy and three days post his sixth cycle of chemotherapy, he presented to the emergency department with signs of shock and evisceration of small bowel via a dehiscence of the mucocutaneous junction at the superior aspect of the loop ileostomy. We discuss this unusual case of late parastomal evisceration.
Parastomal evisceration is caused by a mucocutaneous dehiscence. Risk factors such as coughing, increased intra-abdominal pressure, emergency surgery, and stomal prolapse or hernia can all be predisposing factors.
Parastomal evisceration is a life-threatening complication that requires urgent assessment, resuscitation, and early referral to the surgical team for intervention.
造口旁疝是一种非常罕见的造口并发症，目前文献中仅报道了少数病例。它可发生在回肠造口术或结肠造口术后的早期或晚期，在急诊和择期手术中均有报道。病因可能是多因素的，但已确定了一些易导致其发生的危险因素。早期识别和及时的手术评估是必要的，治疗取决于患者、病理和环境因素。
一名50岁患有梗阻性直肠癌的男性，在开始新辅助化疗（卡培他滨和奥沙利铂）之前接受了择期手术，以创建临时袢式回肠造口。他有肥胖、酗酒史，目前仍吸烟。他的术后病程因非梗阻性造口旁疝而复杂化，在新辅助治疗期间采用非手术治疗。在他的袢式回肠造口术后七个月，第六周期化疗后三天，他因休克体征和通过袢式回肠造口上方黏膜皮肤交界处裂开导致小肠脏器脱出而就诊于急诊科。我们讨论了这例罕见的晚期造口旁疝病例。
造口旁疝是由黏膜皮肤裂开引起的。咳嗽、腹内压增加、急诊手术以及造口脱垂或疝等危险因素均可能是诱发因素。
造口旁疝是一种危及生命的并发症，需要紧急评估、复苏，并尽早转诊至外科团队进行干预。
