Parastomal Gallbladder Herniation as an Incidental Preoperative Computed Tomography Finding

Area of Science:

• Gastroenterology
• Abdominal Imaging
• Surgical Management

Background:

• A 65-year-old female patient presented with a decade-old ileostomy complicated by electrolyte imbalances, high output, weight loss, and a parastomal hernia.
• The patient underwent multiple prior abdominal surgeries, necessitating a planned conversion to a permanent sigmoidostomy.

Observation:

• Computed tomography (CT) revealed small bowel loops and an unusual cystic lesion within the parastomal hernia sac.
• The absence of the gallbladder in its usual location, coupled with no history of cholecystectomy, raised suspicion for gallbladder herniation.

Findings:

• Intraoperative confirmation of the gallbladder within the parastomal hernial sac.
• The gallbladder showed no signs of acute cholecystitis, allowing for uncomplicated reduction into the peritoneal cavity.
• The patient successfully underwent conversion from ileostomy to end colostomy.

Implications:

• This case underscores the value of preoperative CT imaging in diagnosing rare parastomal hernia contents.
• Accurate diagnosis facilitated a streamlined surgical approach, avoiding simultaneous cholecystectomy.
• Successful management led to improved patient quality of life with resolution of ostomy-related complications.