Spontaneous Evisceration of a Parastomal Hernia with Small- Bowel Strangulation: A Case Report

BACKGROUND Evisceration of intra-abdominal organs is a rare, serious event. It normally occurs in 2 particular situations: postoperative or post-traumatic. Spontaneous evisceration of abdominal contents is an uncommon condition. CASE REPORT An 83-year-old male patient, with a significant history of multiple comorbidities, prior abdomino-perineal resection for rectal adenocarcinoma, and ongoing chemotherapy for metastatic disease, presented to the Emergency Department with spontaneous evisceration of multiple small-bowel loops. The evisceration occurred through the site of a recurrent parastomal hernia, located on the left lateral aspect of the abdominal wall, adjacent to the colostomy site. The evisceration occurred due to rupture of the overlying skin in the area of the hernia sac, adjacent to the colostomy. At the time of the hospital presentation, approximately 6 hours after evisceration, the intestinal loops appeared congested. An emergency surgery was undertaken, involving segmental resection of the ileum with primary anastomosis and no mesh repair of the parastomal hernia, due to contamination. The postoperative outcome was slowly favorable and the patient was discharged on the 8th postoperative day. CONCLUSIONS This case report presents a rare but potentially serious clinical situation of spontaneous evisceration occurring in the context of a parastomal hernia in a patient with neoplasia.