Hospital: Hospital universitario de Getafe.-
Ciudad:
Nº:
Aut@r o Autores: G. Ugena Diaz, J. Vega Villar, J. Fernandez Cueto, F. Ballesta Vicente, E. Romo Escudero, A. Berral Santana.,
Presentación:
A 95-year-old woman presented to emergency department with abdominal pain, nausea and fever. Her prior medical history included a left hemicolectomy due to a colon cancer 8 years prior to the admission. Physical exam revealed a painful non-reductible mass in the right upper quadrant, at the right edge of the colostomy site. A contrast-enhanced computed tomography (CT) revealed a large parastomal hernia at the colostomy site. It contained a dilated, thick-walled gallbladder with irregular mural enhancement, herniated through the abdominal wall defect from the stoma. Gallstones were noted within the gallbladder and the common bile duct was mildly dilated. The bowel loop forming the stoma was collapsed by the gallbladder and there were signs of large bowel obstruction at the right colon. The main diagnostic consideration at that point was gangrenous cholecystitis and incarcerated gallbladder parastomal hernia causing right bowel obstruction. The surgical team was consulted but cholecystectomy was not recommended because of the patient’s age and poor functional status. Her condition rapidly deteriorated and she died one day later.-
Discusión:
Parastomal hernias containing the gallbladder are extremely rare. Less than ten cases have ever been reported. Most parastomal hernias consist of small bowel, colon, or omentum in addition and exceptionally gastric or gallbladder herniation. The complications include strangulation, obstruction, or visceral perforation and warrant urgent exploration. Nevertheless, multiple factors in elderly patients may predispose to gallbladder herniation, such as loss of visceral fat and elastic tissue, shrinkage of the liver, and ultimately lengthening of the gallbladder’s mesentery. The strangulation of the gallbladder may rapidly lead to ischemic wall changes and cholecystitis. CT and US are the imaging modality of choice for diagnosis. Surgery was the management choice in most of the published cases, but medical management with antibiotics might be the treatment of choice in poor surgical candidates.-
Conclusión:
Parastomal hernias containing the gallbladder are extremely rare. Less than ten cases have ever been reported. Most parastomal hernias consist of small bowel, colon, or omentum in addition and exceptionally gastric or gallbladder herniation. The complications include strangulation, obstruction, or visceral perforation and warrant urgent exploration. Nevertheless, multiple factors in elderly patients may predispose to gallbladder herniation, such as loss of visceral fat and elastic tissue, shrinkage of the liver, and ultimately lengthening of the gallbladder’s mesentery. The strangulation of the gallbladder may rapidly lead to ischemic wall changes and cholecystitis. CT and US are the imaging modality of choice for diagnosis. Surgery was the management choice in most of the published cases, but medical management with antibiotics might be the treatment of choice in poor surgical candidates.-
Bibliografía:
– Goubault P, Mohkam K, Rode A, Ducerf C, Mabrut JY, Golse N et al. Gallbladder torsion within incisional hernia: an original cholecystitis. SpringerPlus. 2015,4(1). – Frankl J, Michaloudu M, Maegawua F. Parastomal gallbladder hernia in a septic patient.