Spontaneous Rupture of a Parastomal Hernia and Small Bowel Evisceration due to Pembrolizumab Skin Damage—A Case Report—

Abstract

A 67-year-old woman was diagnosed with stage IV lung adenocarcinoma and received active chemotherapy. The following year, she underwent an emergency Hartmann's procedure (HP) for sigmoid colon perforation with panperitonitis. Although the ostomy was complicated by a parastomal hernia 12 months later, she did not undergo surgical intervention for this ostomy-related complication due to the advanced staged lung cancer treated actively by pembrolizumab. Pemphigoid and skin ulceration around the stoma, which were thought to be associated with pembrolizumab, were observed, and she was treated conservatively. Three years after the HP, she was brought to our clinic because she developed spontaneous rupture of a parastomal hernia and small bowel evisceration with strangulation, and emergency surgery was performed. A nonviable small bowel segment and the hernia sac were resected, anastomosis was performed, and the abdominal wall was simply closed. The patient's postoperative course was uneventful. This case of a parastomal hernia as a rare stoma-related complication with skin ulceration and prolapse of the small intestine due to rupture of the abdominal wall during pembrolizumab therapy is reported.