Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication
Abstract Background Parastomal evisceration represents a preventable surgical complication that should not occur with appropriate technical diligence and surgical skills. While late parastomal hernias are well described in the literature, there is a paucity of reports on the early postoperative occu...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-10-01
|
| Series: | Patient Safety in Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13037-023-00379-4 |
| _version_ | 1797557222382764032 |
|---|---|
| author | Anis Hasnaoui Racem Trigui Sihem Heni Salma Kacem |
| author_facet | Anis Hasnaoui Racem Trigui Sihem Heni Salma Kacem |
| author_sort | Anis Hasnaoui |
| collection | DOAJ |
| description | Abstract Background Parastomal evisceration represents a preventable surgical complication that should not occur with appropriate technical diligence and surgical skills. While late parastomal hernias are well described in the literature, there is a paucity of reports on the early postoperative occurrence of parastomal intestinal evisceration. Case presentation An urgent laparotomy was performed on a 58-year-old female patient for an acute cecal perforation with generalized peritonitis related to underlying colon cancer. Intraoperative revelations necessitated a carcinologic right colectomy and the creation of an end-loop ileocolostomy. Following six sessions of adjuvant chemotherapy, Computed tomography scans raised uncertainties about the presence of peritoneal carcinomatosis. Consequently, a collaborative decision was reached in a multidisciplinary discussion to conduct a surgical biopsy of these deposits before reinstating digestive continuity. The surgical procedure started with stoma mobilization. However, adhesions and a relatively confined aperture curtailed a comprehensive peritoneal cavity exploration. Thus, a midline incision was executed. The verdict from the frozen section examination affirmed metastatic presence, prompting the retention of the stoma. Within 48 h post-surgery, an early-stage parastomal evisceration occurred, stemming from an inadequately sealed aponeurotic sheath. The exposed bowel surface was encased in fibrin, necessitating meticulous irrigation with a warm saline solution before repositioning it within the peritoneal cavity. Accurate adjustment of the aponeurosis closure ensued, coupled with a meticulous reconstitution of the stoma. The postoperative course was uneventful. The patient was subsequently referred for hyperthermic intraperitoneal chemotherapy. Conclusions Preventing parastomal evisceration requires adherence to established stoma-creation protocols, including creating a properly sized fascial opening and secure fixation. In instances of excessive fascial opening, ensuring a tension-free and meticulous closure is imperative. |
| first_indexed | 2024-03-10T17:14:18Z |
| format | Article |
| id | doaj.art-8c4679403ee94abe802c05a5a1580322 |
| institution | Directory Open Access Journal |
| issn | 1754-9493 |
| language | English |
| last_indexed | 2024-03-10T17:14:18Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Patient Safety in Surgery |
| spelling | doaj.art-8c4679403ee94abe802c05a5a15803222023-11-20T10:32:50ZengBMCPatient Safety in Surgery1754-94932023-10-011711710.1186/s13037-023-00379-4Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complicationAnis Hasnaoui0Racem Trigui1Sihem Heni2Salma Kacem3Department of General Surgery, Menzel Bourguiba HospitalDepartment of General Surgery, Menzel Bourguiba HospitalDepartment of General Surgery, Menzel Bourguiba HospitalDepartment of General Surgery, Menzel Bourguiba HospitalAbstract Background Parastomal evisceration represents a preventable surgical complication that should not occur with appropriate technical diligence and surgical skills. While late parastomal hernias are well described in the literature, there is a paucity of reports on the early postoperative occurrence of parastomal intestinal evisceration. Case presentation An urgent laparotomy was performed on a 58-year-old female patient for an acute cecal perforation with generalized peritonitis related to underlying colon cancer. Intraoperative revelations necessitated a carcinologic right colectomy and the creation of an end-loop ileocolostomy. Following six sessions of adjuvant chemotherapy, Computed tomography scans raised uncertainties about the presence of peritoneal carcinomatosis. Consequently, a collaborative decision was reached in a multidisciplinary discussion to conduct a surgical biopsy of these deposits before reinstating digestive continuity. The surgical procedure started with stoma mobilization. However, adhesions and a relatively confined aperture curtailed a comprehensive peritoneal cavity exploration. Thus, a midline incision was executed. The verdict from the frozen section examination affirmed metastatic presence, prompting the retention of the stoma. Within 48 h post-surgery, an early-stage parastomal evisceration occurred, stemming from an inadequately sealed aponeurotic sheath. The exposed bowel surface was encased in fibrin, necessitating meticulous irrigation with a warm saline solution before repositioning it within the peritoneal cavity. Accurate adjustment of the aponeurosis closure ensued, coupled with a meticulous reconstitution of the stoma. The postoperative course was uneventful. The patient was subsequently referred for hyperthermic intraperitoneal chemotherapy. Conclusions Preventing parastomal evisceration requires adherence to established stoma-creation protocols, including creating a properly sized fascial opening and secure fixation. In instances of excessive fascial opening, ensuring a tension-free and meticulous closure is imperative.https://doi.org/10.1186/s13037-023-00379-4Parastomal eviscerationPostoperative complicationColon SurgeryStomaSurgical wound dehiscence |
| spellingShingle | Anis Hasnaoui Racem Trigui Sihem Heni Salma Kacem Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication Patient Safety in Surgery Parastomal evisceration Postoperative complication Colon Surgery Stoma Surgical wound dehiscence |
| title | Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication |
| title_full | Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication |
| title_fullStr | Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication |
| title_full_unstemmed | Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication |
| title_short | Early postoperative parastomal evisceration after explorative laparotomy: case report of a rare and potentially life-threatening surgical complication |
| title_sort | early postoperative parastomal evisceration after explorative laparotomy case report of a rare and potentially life threatening surgical complication |
| topic | Parastomal evisceration Postoperative complication Colon Surgery Stoma Surgical wound dehiscence |
| url | https://doi.org/10.1186/s13037-023-00379-4 |
| work_keys_str_mv | AT anishasnaoui earlypostoperativeparastomaleviscerationafterexplorativelaparotomycasereportofarareandpotentiallylifethreateningsurgicalcomplication AT racemtrigui earlypostoperativeparastomaleviscerationafterexplorativelaparotomycasereportofarareandpotentiallylifethreateningsurgicalcomplication AT sihemheni earlypostoperativeparastomaleviscerationafterexplorativelaparotomycasereportofarareandpotentiallylifethreateningsurgicalcomplication AT salmakacem earlypostoperativeparastomaleviscerationafterexplorativelaparotomycasereportofarareandpotentiallylifethreateningsurgicalcomplication |