Parastomal hernia

A hernia is an abnormal protrusion of a viscus (e.g. bowel) through its normal containing wall (e.g. the abdominal muscle wall).  A parastomal hernia is a hernia that occurs adjacent to a stoma, usually either an ileostomy or a colostomy.  When a stoma is constructed during surgery, a hole is made in the abdominal wall to bring the bowel end to the skin surface where waste goes into a bag.  This hole, over time, gradually enlarges due to the pressure inside the abdomen trying to push the abdominal contents out through it; it is therefore inevitable that to some degree most patients with a stoma will get a hernia.  However, if the hernia is small, it might not be noticeable.

What symptoms are associated with a parastomal hernia?

Patients may notice a bulge next to their stoma that becomes more prominent when they stand or strain.  Other than noticing a bulge, there are often no other symptoms.  However, patients may experience discomfort or pain.  The bulge can also lead to problems with the stoma appliance bag remaining stuck to the abdominal wall.  Rarely, bowel may come out into the hernia and strangulate, leading to severe pain and vomiting; this is a surgical emergency.

How are parastomal hernias managed?

Often, no intervention is required if the hernia is causing no trouble.  If the bulge is problematic, either for cosmesis or interfering with the stoma bag sticking, a support belt can be worn.  Your stoma nurse will be able to advise you about this.

Surgery is reserved for parastomal hernias that have significant symptoms.  A number of surgical options are available, including laparoscopic (keyhole) repair of the hernia, local open repair of the hernia, or repositioning of the stoma on the other side of the abdomen.  Your surgeon will be able to advise you on the best option for you, along with the risks associated with the treatment.

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