**5.8 Parastomal hernia**

The parastomal hernia, a protrusion of the bowel or loops of intestine through the fascial opening into the subcutaneous tissue around the stoma, occurs months to years after surgery because of surgical technical error or following gradual enlargement of the fascial defect. The incidence rate for parastomal hernia varies with the type and age of the stoma and with surgical technique. It is caused by lack of preoperative demarcation of stoma site with exteriorization outside the rectus abdominal muscle. The main risk factors are intra-abdominal pressure, advanced age, obesity, chronic cough, and long-term use of corticosteroids. If the cause is associated to slight peristomal weakness, a common finding in patients with colostomy, surgical correction is usually not necessary. However some hernias interfere with the proper use of the pouch, and surgery for hernia correction is mandatory [17].

Parastomal hernia presents as a bulge around the stoma and may be partial or circumferential. In supine position the bulge may reduce in size, whereas sitting or standing position, Valsalva maneuver, or cough tends to protrude the hernia, whereas lying down and stoma manual compression intrude the hernia back to the abdomen. The hernia change in position makes the pouching seal more difficult. CT scan with oral contrast confirms the diagnosis. The patient may complain a feeling of discomfort or fullness, and if the stoma incarcerates, the patient presents with an acute obstructed abdomen. The use of support binders when prolonged episodes of

#### **Figure 8.**

*Stoma necrosis. (A) Partial necrosis; (B) extensive necrosis. An endoscopy is useful to evaluate if the necrosis extends below the level of the fascia. Surgery may be necessary.*

**49**

**Figure 10.**

**Figure 9.**

*stoma stenosis (B).*

*Intestinal Ostomy Complications and Care DOI: http://dx.doi.org/10.5772/intechopen.85633*

**5.9 Stenosis**

treatment vary from 33 to 76% [17, 18] (**Figure 9**).

increased intra-abdominal pressures are expected (e.g., heavy lifting or hard physical activity) is recommended. Asymptomatic patients can be treated conservatively by the use of support belt or binder, for example, by constipation prevention with diet modification and laxative or stool softener. If signs of obstruction, incarceration, perforation, or recurrent pouching difficulties are present, the patient should be referred to a surgeon. Surgery repair of parastomal hernia can be done by fascial repair, prosthetic mesh, or stoma relocation; however recurrence rates after surgical

Stenosis of the stomy opening is characterized by stricture or retraction which makes drainage of the intestinal effluent more difficult. Its incidence is related to the surgical technique itself or as a consequence of precocious complications such as partial necrosis, recurrent inflammatory processes, Crohn's disease, weight gain, and tumor recurrence. The symptoms include abdominal excess of gases, frequent cramps and diarrhea, as well as thin feces. The best option for the treatment of this complication is surgery, but increase of hydric ingestion and eating foods which favor the feces softening may improve the ostomy output [4, 5] (**Figure 10**).

*Stoma stenosis. Note the retraction of skin (A) and the scar tissue around the stoma opening in a chronic* 

*Parastomal hernia in a prolapsed stoma (A) and a huge parastomal hernia (B).*

*Intestinal Ostomy Complications and Care DOI: http://dx.doi.org/10.5772/intechopen.85633*

increased intra-abdominal pressures are expected (e.g., heavy lifting or hard physical activity) is recommended. Asymptomatic patients can be treated conservatively by the use of support belt or binder, for example, by constipation prevention with diet modification and laxative or stool softener. If signs of obstruction, incarceration, perforation, or recurrent pouching difficulties are present, the patient should be referred to a surgeon. Surgery repair of parastomal hernia can be done by fascial repair, prosthetic mesh, or stoma relocation; however recurrence rates after surgical treatment vary from 33 to 76% [17, 18] (**Figure 9**).
