Kaneko Tomoaki, Ushigome Mitsunori, Kagami Satoru, Yoshida Kimihiko, Miura Yasuyuki, Suzuki Takayuki, Kurihara Akiharu, Shimada Nagato, Funahashi Kimihiko
Department of Gastroenterological Surgery, Toho University Medical Center Omori Hospital, Tokyo, Japan.
Department of Surgery, Sagamihara Central Hospital, Sagamihara, Kanagawa, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0002. Epub 2025 Jul 23.
Parastomal hernias with loss of domain are those in which it is difficult to return the hernia contents to the abdominal cavity and close the hernia orifice using standard mesh repair methods. We encountered a case in which abdominal wall closure was achieved safely by reducing the hernia content through bowel resection.
The patient, a 50-year-old man, had a history of ulcerative colitis with a complex anal fistula, resulting in construction of a stoma with double orifices using the sigmoid colon. He presented requesting surgery because his parastomal hernia had increased greatly in size, and stoma management became difficult. Abdominal CT showed a large hernia with an incisional hernia volume to peritoneal volume ratio >80%. Total colectomy was performed, and a stoma was reconstructed at another site. The hernia orifice was closed using a fascia lata graft. No postoperative abdominal compartment syndrome was observed. Six months later, abdominal CT showed a small hernia of the abdominal wall; however, the stoma was easily managed, and the patient's quality of life improved.
Bowel resection for volume reduction may be an effective option for the repair of incisional hernias with loss of domain.
伴有腹腔容量丧失的造口旁疝是指难以将疝内容物回纳至腹腔并使用标准补片修补方法关闭疝孔的情况。我们遇到一例通过肠切除减少疝内容物后安全实现腹壁闭合的病例。
患者为一名50岁男性，有溃疡性结肠炎合并复杂性肛瘘病史，导致使用乙状结肠构建了双孔造口。他因造口旁疝体积大幅增大且造口管理困难而前来要求手术。腹部CT显示巨大疝，切口疝体积与腹腔体积之比>80%。行全结肠切除术，并在另一部位重建造口。使用阔筋膜移植关闭疝孔。未观察到术后腹腔间隔室综合征。6个月后，腹部CT显示腹壁有小疝；然而，造口易于管理，患者生活质量得到改善。
通过肠切除减少容量可能是修复伴有腹腔容量丧失的切口疝的有效选择。
