Complicated Parastomal Hernia: Iatrogenic Perforation in the Efferent Loop

Background: The complication of a parastomal hernia is extremely rare. Only some perforation in the proximal colon of a colostomy have been previously reported. Moreover, the extraperitoneal approach is infrequent to the treatment of this type of hernias. We observed a case of perforation, whose etiology was probably iatrogenic, in the efferent loop of a right transverse colostomy.

Case Report: A 62-years-old male who underwent a right transverse colostomy for a traumatic section of the colon 20 years ago, went to the Emergency Service for a subocclusive case. An incorrect management of a rectal catheter through the colostomy might have developed a perforation in the efferent loop of the colostomy. An extracavitary approach was made for avoid the midline dought to he presented a catastrophic abdomen because of previous surgeries. The relevance of this case report is based on the diagnostic difficulty, the hernia content, the possible associated iatrogenesis and the vital risk for the patient, as well as the treatment carried out.

Discussion and Conclusions: Parastomal hernia has an important prevalence and this condition implies high frequency to the Emergency Department. It is crucial to the current guidelines the use of prophylactic mesh in terminal stomas to prevent it. In addition, all sanitary personnel must know the basis management of a stoma to avoid possible iatrogenic complications. The peristomal approach during the surgery was critical to prevent a higher morbidity and mortality post intervention, being possible to make a right hemicolectomy through this way.