Parastomal hernias (alternative plural: herniae) are defined as the protrusion of abdominal contents through an abdominal wall defect in the vicinity of the stoma. The reported incidence of parastomal hernia (PSH) is 30-65% with the highest incidence in patients with a colostomy (~50%) 4.
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Clinical features
Pain and problems with stoma appliance, often leading to leakage are seen in approximately in one-third patients. Peristomal dermatitis due to peristomal leakage, unpleasant odor and spoilation of clothes are other common presenting complaints. Bowel obstruction, perforation, and strangulation can occur in up to 15% of the patients 4.
Etiology/risk factors
Reported risk factors for the development of PSH are old age (> 60 years), sarcopenic obesity, history of abdominal hernia, malnutrition, chronic steroid use, and factors increasing intraabdominal pressure (i.e. chronic cough, constipation, prostatism, and ascites) 4.
Development of PSH depends on the size of ostomy opening made in the abdominal wall at the time of surgery which can be easily measured on postoperative imaging. An abdominal wall defect which is unnecessary large is associated with high risk of PSH development. An abdominal wall defect diameter of ≥3 cm at the stoma site has been reported to be associated with an increased risk of PSH development, and the risk increases 10% for every millimeter (mm) increase in the aperture size. Development of PSH is unlikely with an ostomy opening diameter smaller than 25 mm as measured on the postoperative CT 4.
COPD (chronic coughing leading to increased abdominal pressure), prolonged surgery time and larger diameter of the abdominal wall defect at the ostomy site are the most important independent predictors of the PSH development 4. Frequency of PSH development can be reduced with prophylactic mesh placement when a relatively large abdominal wall defect at the colostomy site is inevitable 4.
Classification
The hernia may contain a loop of bowel forming the stoma itself, omentum, and/or intestinal loops other than that forming the stoma. Based on the contents of the sac, various classification schemes have been developed 2,3. However, clinically significant (and reportable) findings include presence or absence of hernia, bowel obstruction due to hernia and growth of sac since the last examination.
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