Late parastomal evisceration: A case report of a rare complication following loop ileostomy for an obstructing rectal cancer

International Journal of Surgery Case Reports · 3 authors, 2 centres

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TL;DR

He had a history of obesity, alcohol excess, and current smoking, and reported a precipitating coughing fit.

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He had a history of obesity, alcohol excess, and current smoking, and reported a precipitating coughing fit.

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case_report

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surgery

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ORIGINAL PAPER

PMC10033943

Late parastomal evisceration: A case report of a rare complication following loop ileostomy for an obstructing rectal cancer

International Journal of Surgery Case Reports

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ABSTRACT

Abstract Introduction and importance 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. Case presentation 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. Clinical discussion 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. Conclusion Parastomal evisceration is a life-threatening complication that requires urgent assessment, resuscitation, and early referral to the surgical team for intervention. Keywords: Parastomal evisceration, Ileostomy, General surgery, Case report

CITATION EXPORT

Sara Izwan, Omattage Mahasha Perera, Stephen Guy. Late parastomal evisceration: A case report of a rare complication following loop ileostomy for an obstructing rectal cancer. International Journal of Surgery Case Reports. (2023). https://doi.org/10.1016/j.ijscr.2023.107936

AUTHORS

3 · 2 CENTRES

Sara Izwan, Omattage Mahasha Perera, Stephen Guy

aDepartment of General Surgery, Gold Coast University Hospital, Southport, QLD 4215, Australia
bSchool of Medicine and Dentistry, Griffith University, Southport, QLD 4215, Australia