A case of stomal perforation treated by local surgeryto avoid reforming the stoma by laparotomy

Abstract

Background: Stomal perforation often requires relocation of the stoma with laparotomy, but it is difficult to resect and reform the stoma at the same time. A case of stomal perforation of parietal portion type treated by local surgery to avoid stoma relocation by laparotomy is reported.

Case: A 77-year-old woman with an end colostomy after Hartmann's operation for perforated sigmoid diverticulosis visited her previous doctor with complaints of peristomal distention and pain. Abdominal computed tomography showed retention of feces and free air under peristomal skin. She was diagnosed as having stomal perforation and referred to our hospital for emergency surgery. An incision was made into peristomal skin to remove the feces, and intestinal perforation was found in the parietal portion of the stomal limb. She had a parastomal hernia and abdominal fascia dehiscence, but the peritoneum was preserved, so fecal contamination was localized to within the abdominal wall without peritonitis. The perforated intestine was excised, and the colostomy was reformed, preserving the stomal limb. The patient was discharged on day 38 of hospitalization after postoperative treatment with antibiotics and management by subcutaneous drainage.

Conclusion: In cases of stomal perforation of parietal portion type without peritonitis, it is possible to avoid laparotomy to reform the stoma in the acute phase by performing local drainage and a stoma reformation technique to preserve the stoma limb.