MTP1.11 Rare Visceral involvement in parastomal hernias: A case series of gallbladder and stomach

Aims Parastomal hernias (PH) containing either gallbladder or stomach are exceedingly rare. Such presentations typically occur in surgically complex, multiply comorbid patients, representing a significant operative challenge. The authors present two cases; cholecystic and gastric PH, both managed conservatively. Methods A 76-year-old female with an extensive surgical history and ileostomy in-situ presented with abdominal pain and non-bilious vomiting. Computed Tomography (CT) scanning demonstrated a parastomal hernia containing small bowel loops and gallbladder with multiple gallstones, without signs of cholecystitis. Separately, a 90-year-old female with an end colostomy following a Hartmann’s procedure presented with vomiting, reduced stoma output and anorexia. CT scanning showed a large PH containing duodenum and the distal half of the stomach, resulting in gastric outlet obstruction. Results The gallbladder PH was manually reduced and the gallbladder spontaneously returned to its anatomical position, later developing gallstone pancreatitis managed with Endoscopic retrograde cholangiopancreatography. The gastric PH was managed conservatively with nasogastric decompression and resolution of obstruction. Subsequent repeated admissions with gastric outlet obstruction occurred and were managed conservatively. Conclusions Parastomal herniation of the gallbladder or stomach is a rare but clinically significant complication. As a result, diagnosis may be challenging and is most reliably confirmed with imaging. Currently no surgical consensus exists regarding the management of these presentations and accordingly, case specific characteristics are necessary to guide surgical intervention.