From the Guidelines
The medical term for protrusion of internal organs through a stoma site is a parastomal hernia. This condition occurs when abdominal contents, typically intestines, protrude through the weakened abdominal wall around a stoma [ 1 ]. Parastomal hernias develop in approximately 30-50% of patients with stomas, particularly colostomies and ileostomies. They result from the surgical creation of an opening in the abdominal wall, which creates a potential weak point where pressure can force internal organs through. Risk factors include obesity, smoking, steroid use, and transverse colostomies [ 1 ]. Symptoms may include bulging around the stoma, pain, difficulty with appliance fitting, and in severe cases, bowel obstruction or strangulation requiring emergency intervention.
Some key points to consider in the management of parastomal hernias include:
- Placement of the stoma through the rectus muscle to minimize the risk of hernia formation [ 1 ]
- Avoidance of the use of the transverse colon for stoma creation due to the increased risk of hernia and prolapse [ 1 ]
- Use of a hernia belt for small, reducible parastomal hernias [ 1 ]
- Elective repair for patients with significant pouching issues, pain, or recurrent bowel obstruction [ 1 ]
- Reversal of the ostomy as the most effective parastomal hernia repair when possible [ 1 ]
It is essential to differentiate parastomal hernia from stomal prolapse, which refers to the elongation of the intestinal portion of the stoma [ 1 ]. Stomal prolapse can lead to incarceration and ischemia, requiring emergency surgery, whereas parastomal hernia management options range from conservative approaches to surgical repair [ 1 ].
From the Research
Definition of Parastomal Evisceration
The medical term for protrusion of internal organs through a stoma (surgically created opening) site is parastomal evisceration 2, 3, 4, 5, 6.
Key Characteristics
- Parastomal evisceration is a rare and potentially life-threatening complication of stomas 2, 3, 4, 5, 6.
- It can occur early or late after stoma creation, and its etiology is often multifactorial 3, 4.
- Risk factors for parastomal evisceration include parastomal hernia, stoma prolapse, increased intra-abdominal pressure, and trauma 3, 4, 6.
Clinical Presentation and Management
- Patients with parastomal evisceration often present with signs of shock and evisceration of small bowel through the stoma site 2, 3, 6.
- Urgent surgical evaluation and management are necessary to prevent further complications and improve outcomes 2, 3, 4, 5, 6.
- Surgical treatment may involve reduction of eviscerated contents, stoma refashioning, and repair of any underlying defects 4, 5, 6.