Presentation
Previous Hartmann's for diverticulitis. Clinically - a parastomal hernia with a midline hernia. CT for operative planning of reversal.
Patient Data
Status post Hartmann's procedure with colostomy in the left lower quadrant and rectal stump situated at the level of S1. There is a parastomal hernia, which contains fat and the anterior wall of a loop of small bowel. No evidence of surrounding fatty stranding or fluid to suggest bowel compromise or proximal obstruction of the bowel. The neck measures 36 mm. There is rectus diastasis measuring 10 cm.
The liver is diffusely hypoattenuating, in keeping with steatosis. The spleen, gallbladder, adrenals and kidneys are normal. The stomach, small bowel and appendix are unremarkable.
Diverticula disease is demonstrated within the descending colon. Portal vein and tributaries are patent. Mild intimal calcification of the aorta.
Case Discussion
Parastomal hernias are defined as the protrusion of abdominal contents through an abdominal wall defect adjacent to a stoma.
In the case of the patient, he had both bowel and omentum without the parastomal hernia sack.
The key findings to describe for parastomal hernia's include contents of the sack, neck size of the sack, imaging findings of obstruction or growth of the hernia since prior imaging.
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