Acute Intestinal Obstruction Due to a Parastomal Hernia Ehs Grade Iv

Background Acute complications of parastomal hernias are a demanding entity in the field of abdominal wall reconstruction. Method An 82-year-old female patient with an incisional hernia and parastomal hernia presented at the emergency department due to vomiting and abdominal pain. She had formerly been operated for a rectal cancer with a deviating sigmoideostoma. Results A computed tomography scan could diagnose intestinal obstruction with stomach lying in the incisional hernia and smaller bowel in the parastomal hernia. Per-oral contrast did not proceed sufficiently to the larger bowel, contact was established with the referral hospital for parastomal hernias. A laparoscopy was performed there and after mobilisation of the stomach from the incisional hernia we decided even to mobilise the parastomal hernia to be able to perform an adequate hernia treatment. A smaller bowel perforation was handled by performing a stapled side-to-side anastomosis with the Barcelona technique. After approximation of the incisional as well as the parastomal hernia with slowly resorbable running sutures, a Sugerbaker procedure was performed using a 15 × 15 cm mesh. The incisional hernia was treated by using a 20 × 15 cm IPOM mesh. 10 days postoperatively the patient could be discharged. 2 months postoperatively the patient was completely satisfied with the result of the 4-hour long operation. Conclusion To achieve better outcomes in parastomal hernia treatment, these patients should be ccentralized. By discussing elective treatment much earlier, complicated emergency cases could diminish.