A Case of Peritonitis Due to Perforation of a Sigmoid Colon Colostomy in a Parastomal Hernia

Abstract

We present the case of 61-year-old woman in whom intestinal obstruction had a sigmoid colon loop colostomy due to rectal cancer 4 years earlier. We administered chemotherapy, and performed abdominal perineal rectal resection with combined uterine-vaginal resection. The loop colostomy was left without being rebuilt into a colostomy. The patient was transported to our hospital because of abdominal pain, and was diagnosed as having acute generalized peritonitis due to gastrointestinal perforation in a parastomal hernia sac. Intraoperative findings revealed that the anal side of the sigmoid loop colostomy was perforated in the parastomal hernia sac, with retention of feces and purulent ascites. We resected the perforated intestinal segment and reconstructed a colostomy in the upper left abdomen. It was considered that the anal stump had become adherent to the abdominal wall in the hernia sac, and was compressed and pulled by the twisting of the small intestine and colon that had herniated into the sac, resulting in perforation. This report is significant because ours was a case of intestinal perforation in a parastomal hernia, which is rare.