[Pseudocontinent perineal colostomy: an exceptional complication]

Stoma prolapse is an exceptional and late complication of pseudocontinent perineal colostomy. Very rare cases have been described in the literature. We here report the case of a 75 year old patient with no particular past medical history as well as our therapeutic approach. The patient initially underwent surgery for non-metastatic rectal adenocarcinoma measuring 1 cm from the anal margin after radiochemotherapy. Laparoscopic abdominoperineal resection was performed with confection of a continent perineal colostomy. During follow up, clinical examination showed colon prolapse through the stoma orifice for which he was admitted to hospital for surgery. The complications of pseudocontinent perineal colostomy are mainly related to operative morbidity due to rectal resection (infections and perineal eventrations), to stoma complications (necrosis, prolapse, herniation). Stoma prolapse is an exceptional complication of continent perineal colostomy. Monitoring and patient education on irrigation technique are usually sufficient. Surgery is necessary in patients with bulky hardly reducible voluminous prolapse, embarrassing the patient and with weeping. Surgery is based on simple peristromal resection of the prolapsed segment. It has been reported that prolapsed segment grafting under simple sedation can be performed. Abdominoperineal resection is a mutilating procedure which is poorly perceived by patients. Pseudocontinent perineal colostomy is a simple safe and reproducible technique associated with a relatively low morbidity. Stoma prolapse is a rare and easily treated complication.