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Pinnock N, Vashi A, Marsh JW, Keita MP, Checovich A. Spontaneous Resolution of Parastomal Gallbladder Herniation After Attempted Surgical Intervention: A Case Report and Review of the Literature. Cureus 2023; 15:e37355. [PMID: 37182048 PMCID: PMC10170294 DOI: 10.7759/cureus.37355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Cholecystic parastomal herniation is a rare condition that has only been documented 16 times in the literature. We present a case report and literature review of cholecystic parastomal herniation managed with diagnostic laparoscopy without cholecystectomy or hernia repair. Furthermore, we assess the demographics, presentation, stoma types, and management of cholecystic parastomal hernias across all documented cases.
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Affiliation(s)
- Nahstajia Pinnock
- General Surgery, Carle Health, Urbana, USA
- General Surgery, Carle Illinois College of Medicine, Urbana, USA
| | - Aksal Vashi
- General Surgery, Carle Illinois College of Medicine, Urbana, USA
| | - Jordan W Marsh
- General Surgery, Carle Illinois College of Medicine, Urbana, USA
| | - Mamadi Papus Keita
- General Surgery, Carle Health, Urbana, USA
- General Surgery, Carle Illinois College of Medicine, Urbana, USA
| | - Allyn Checovich
- General Surgery, Carle Health, Urbana, USA
- General Surgery, Carle Illinois College of Medicine, Urbana, USA
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Parastomal Gallbladder Herniation as an Incidental Preoperative Computed Tomography Finding. Case Rep Radiol 2021; 2021:8864347. [PMID: 33628566 PMCID: PMC7892254 DOI: 10.1155/2021/8864347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
Abstract
A 65-year-old woman with a long surgical history was referred to our hospital's Colorectal Unit for ileostomy management. The patient retained an ileostomy for almost a decade after a series of complicated operations she had undergone, which had several side effects such as electrolyte imbalances, high output, weight loss, and a parastomal hernia. Our hospital's colorectal surgeon proposed to replace the ileostomy with a permanent sigmoidostomy and asked for an imaging evaluation of the parastomal hernia content before the surgery. A computed tomography of the abdomen was performed using our Computed Tomography Department's 64-detector row CT scanner after oral administration of contrast media, without intravenous contrast media injection due to allergy. Concerning the parastomal ileostomal hernia, besides small bowel loops with intraluminal gastrografin, inside the parastomal hernial sac, there also was an almost rounded cystic lesion. Absence of the gallbladder at its typical position and no record of cholecystectomy raised suspicion for gallbladder projection inside the sac. Our suspicion was confirmed during the surgery. Nonexisting acute cholecystitis allowed easy reduction of the gallbladder along with the small bowel loops inside the peritoneal cavity, without proceeding to cholecystectomy at the same time. Finally, ileostomy was annulated and an end colostomy was established. Four days after the surgery, the patient was discharged from the hospital and was happy to live an almost normal life thereafter.
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Tajti J, Pieler J, Ábrahám S, Simonka Z, Paszt A, Lázár G. Incarcerated gallbladder in inguinal hernia: a case report and literature review. BMC Gastroenterol 2020; 20:425. [PMID: 33317478 PMCID: PMC7737330 DOI: 10.1186/s12876-020-01569-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Treating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date. Case presentation A 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confirmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confirmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory findings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the significantly ptotic, large gallbladder. Cholecystectomy and Bassini’s repair of the inguinal hernia were performed safely. Conclusions Following a review of the literature, it can be concluded that the finding of incarcerated gallbladder in the content of an inguinal hernia is a rare finding. No other similar emergency case and successful surgical intervention have been reported before.
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Affiliation(s)
- János Tajti
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, 6725, Hungary
| | - József Pieler
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, 6725, Hungary
| | - Szabolcs Ábrahám
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, 6725, Hungary
| | - Zsolt Simonka
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, 6725, Hungary
| | - Attila Paszt
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, 6725, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Semmelweis u. 8., Szeged, 6725, Hungary.
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Moeckli B, Limani P, Clavien PA, Vonlanthen R. Parastomal gallbladder herniation: A case report and review of the literature. Int J Surg Case Rep 2020; 73:338-341. [PMID: 32739522 PMCID: PMC7397696 DOI: 10.1016/j.ijscr.2020.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/12/2020] [Indexed: 12/17/2022] Open
Abstract
Gallbladder herniation is a rare complication of a parastomal hernia, affecting primarily elderly females. For patients with parastomal swelling and pain gallbladder herniation should be included in the differential diagnosis. Elderly patients with multiple comorbidities may benefit from a conservative approach instead of surgery. The use of prophylactic mesh when creating a permanent end colostomy reduces the rate of parastomal hernias.
Introduction Parastomal hernia is a common complication of patients living with an enterostomy. However, a parastomal hernia involving the gallbladder is a rare condition with only eight cases documented in the literature. Presentation of case We report the case of a 69-year old female who underwent an open right hemicolectomy with creation of a colostomy and terminal ileostomy. She presented with parastomal swelling and pain 16 months later. A computed tomography scan revealed a parastomal herniation of the gallbladder. We elected to proceed with a cholecystectomy and hernia repair, the patient was asymptomatic at her last follow-up. Discussion A systematic search of the literature found eight previously published cases. This condition primarily affects elderly females. Five patients were treated surgically and three conservatively, all with a favorable outcome. In frail patients without complicating factors, a conservative treatment approach with surveillance may be safe. We chose a surgical approach due to the symptomatic nature of the presentation and the gallstone containing hernia. This is the first case of a parastomal gallbladder herniation containing a large gallstone. Conclusion This report should help broadening the physician’s differential diagnosis in dealing with patients with symptomatic parastomal hernias and provide an example for diagnosis and management of this complication.
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Affiliation(s)
- Beat Moeckli
- Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland; Department of Surgery, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Perparim Limani
- Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
| | - Pierre-Alain Clavien
- Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Rene Vonlanthen
- Department of Surgery and Transplantation, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
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Rogers P, Lai A, Salama P. Gallbladder complicating a parastomal hernia. J Surg Case Rep 2019; 2019:rjz107. [PMID: 30997013 PMCID: PMC6457066 DOI: 10.1093/jscr/rjz107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
The presence of the gallbladder in a parastomal hernia is exceeding rare. We present the case of a 75-year-old female with a parastomal hernia complicated by presence of the gallbladder. The patient was managed with surgical intervention to repair the hernia and reduce the gallbladder to its correct abdominal position without cholecystectomy. She recovered well from her surgical repair, and was recurrence free at her 6-month outpatient visit. This is the one of seven reported cases of parastomal gallbladder herniation and fits with known pre determinants of advanced age and being female. We present this case due its interesting and novel nature.
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Affiliation(s)
| | - Alvin Lai
- Royal Perth Hospital, Western Australia
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Bakshi C, Ruff S, Caliendo F, Agnew J. Acute cholecystitis in a parastomal hernia causing a small bowel obstruction. J Surg Case Rep 2017; 2017:rjx235. [PMID: 29423157 PMCID: PMC5798022 DOI: 10.1093/jscr/rjx235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 11/29/2017] [Indexed: 11/26/2022] Open
Abstract
A parastomal hernia is the abnormal protrusion of intra-abdominal tissue and organs through a defect in the abdominal wall around an ostomy. Commonly, they involve intra-abdominal fat, omentum or bowel. However, there are rare cases that involve other organs. We present the case of an 89-year-old gentleman with a gallbladder in his parastomal hernia. Due to his acute cholecystitis, the distended gallbladder compressed adjacent bowel loops in the parastomal hernia, resulting in a mechanical bowel obstruction. The patient was treated with antibiotics and a nasogastric tube. As his cholecystitis resolved his ostomy function returned.
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Affiliation(s)
- Chetna Bakshi
- Department of Surgery, Northwell Health, Manhasset, NY 11030, USA
| | - Samantha Ruff
- Department of Surgery, Northwell Health, Manhasset, NY 11030, USA
| | - Frank Caliendo
- Colon and Rectal Surgical Specialists of New York, Garden City, NY 11530, USA
| | - Jennifer Agnew
- Colon and Rectal Surgical Specialists of New York, Garden City, NY 11530, USA
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Frankl J, Michailidou M, Maegawa F. Parastomal gallbladder hernia in a septic patient. Radiol Case Rep 2017; 12:508-510. [PMID: 28828113 PMCID: PMC5552004 DOI: 10.1016/j.radcr.2017.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 05/20/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022] Open
Abstract
Parastomal gallbladder herniation is a rare complication of enterostomies with only 6 previously reported cases. Most cases have occurred in elderly women. Patients typically presented with acute abdominal pain and the majority was managed operatively. Here, we report the clinical course of an 88-year-old female who presented with signs of sepsis and minimal abdominal symptoms. She was subsequently found to have a parastomal gallbladder herniation and Klebsiella pneumoniae bacteremia. Given the patient's multiple comorbidities, she was managed nonoperatively with manual reduction of the parastomal hernia and antibiotics.
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Affiliation(s)
- Joseph Frankl
- University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Maria Michailidou
- Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724, USA
| | - Felipe Maegawa
- Department of Surgery, University of Arizona College of Medicine, 1501 N. Campbell Ave., Tucson, AZ 85724, USA.,Department of Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ 85724, USA
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Wong KC. How to apply clinical cases and medical literature in the framework of a modified "failure mode and effects analysis" as a clinical reasoning tool--an illustration using the human biliary system. J Med Case Rep 2016; 10:85. [PMID: 27048215 PMCID: PMC4822271 DOI: 10.1186/s13256-016-0850-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 02/25/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clinicians use various clinical reasoning tools such as Ishikawa diagram to enhance their clinical experience and reasoning skills. Failure mode and effects analysis, which is an engineering methodology in origin, can be modified and applied to provide inputs into an Ishikawa diagram. METHOD The human biliary system is used to illustrate a modified failure mode and effects analysis. The anatomical and physiological processes of the biliary system are reviewed. Failure is defined as an abnormality caused by infective, inflammatory, obstructive, malignancy, autoimmune and other pathological processes. The potential failures, their effect(s), main clinical features, and investigation that can help a clinician to diagnose at each anatomical part and physiological process are reviewed and documented in a modified failure mode and effects analysis table. Relevant medical and surgical cases are retrieved from the medical literature and weaved into the table. RESULTS A total of 80 clinical cases which are relevant to the modified failure mode and effects analysis for the human biliary system have been reviewed and weaved into a designated table. The table is the backbone and framework for further expansion. Reviewing and updating the table is an iterative and continual process. The relevant clinical features in the modified failure mode and effects analysis are then extracted and included in the relevant Ishikawa diagram. CONCLUSIONS This article illustrates an application of engineering methodology in medicine, and it sows the seeds of potential cross-pollination between engineering and medicine. Establishing a modified failure mode and effects analysis can be a teamwork project or self-directed learning process, or a mix of both. Modified failure mode and effects analysis can be deployed to obtain inputs for an Ishikawa diagram which in turn can be used to enhance clinical experiences and clinical reasoning skills for clinicians, medical educators, and students.
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Affiliation(s)
- Kam Cheong Wong
- Bathurst Rural Clinical School, Western Sydney University, Bathurst, NSW, Australia. .,School of Rural Health, University of Sydney, Orange, NSW, Australia. .,George Street Medical Practice, Bathurst, NSW, Australia.
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Abstract
Superior lumbar triangle hernia, also known as Grynfeltt-Lesshaft hernia, denotes a subtype of abdominal wall hernia, and more specifically of lumbar hernia, occurring between the 12th rib, the internal oblique muscle, and the quadratus lumborum muscle. We report the case of a 92-year-old female patient in which this form of hernia occurred, complicated by incarceration and acute bowel obstruction. The discussion contains a short résumé of the different kinds of abdominal wall hernias.
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Affiliation(s)
- Max Scheffler
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Julien Renard
- Department of Urology, Geneva University Hospital, Geneva, Switzerland
| | - Pascal Bucher
- Department of General and Gastrointestinal Surgery, Clinique La Colline, Geneva, Switzerland
| | - Diomidis Botsikas
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
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Goubault P, Mohkam K, Rode A, Ducerf C, Mabrut JY, Golse N. Gallbladder torsion within incisional hernia: an original cholecystitis. SPRINGERPLUS 2015; 4:305. [PMID: 26155444 PMCID: PMC4486646 DOI: 10.1186/s40064-015-1112-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 06/22/2015] [Indexed: 11/10/2022]
Abstract
Gallbladder torsion with ischemic wall necrosis is a rare condition, as gallbladder herniation. We describe here an original case of a patient with a symptomatic incisional hernia containing a gangrenous gallbladder twisted about its pedicle. We report preoperative findings on CT-scan and emergency surgical management.
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Affiliation(s)
- Pierre Goubault
- Digestive Surgery and Liver Transplantation Department, Croix-Rousse University Hospital, University Claude-Bernard Lyon-1, 103 Grande rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Kayvan Mohkam
- Digestive Surgery and Liver Transplantation Department, Croix-Rousse University Hospital, University Claude-Bernard Lyon-1, 103 Grande rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Agnès Rode
- Radiology Department, Croix-Rousse University Hospital, University Claude-Bernard Lyon-1, Lyon, France
| | - Christian Ducerf
- Digestive Surgery and Liver Transplantation Department, Croix-Rousse University Hospital, University Claude-Bernard Lyon-1, 103 Grande rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Jean-Yves Mabrut
- Digestive Surgery and Liver Transplantation Department, Croix-Rousse University Hospital, University Claude-Bernard Lyon-1, 103 Grande rue de la Croix Rousse, 69317 Lyon Cedex 04, France
| | - Nicolas Golse
- Digestive Surgery and Liver Transplantation Department, Croix-Rousse University Hospital, University Claude-Bernard Lyon-1, 103 Grande rue de la Croix Rousse, 69317 Lyon Cedex 04, France
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Case report and operative management of gallbladder herniation. BMC Surg 2015; 15:72. [PMID: 26063048 PMCID: PMC4464702 DOI: 10.1186/s12893-015-0056-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Incarcerated abdominal wall hernias may contain a variety of contents, but very rarely contains the gallbladder. This rare diagnosis is often not considered and, when diagnosed, has a different management approach. The experience of the small number of case reports have yet to be collected and summarised. Case presentation We report a presentation and management of an 85 year old Caucasian female with a gallbladder hernia into a parastomal defect, and outline the operative management. Conclusion Incarcerated gallbladder hernia is an extremely unusual condition, best diagnosed by CT scan. Management should involve operative reduction, cholecystectomy and consideration of repair of the defect.
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