Gallbladder herniation and cholecystitis within a parastomal hernia: a case report and literature review

Abstract

: Gallbladder herniation with associated cholecystitis is an unusual presentation amongst parastomal hernias. We describe a case of a 63-year-old lady with a previous subtotal colectomy and end ileostomy for perforated diverticulitis, who developed a parastomal hernia containing the gallbladder with consequent cholecystitis and pancreatitis. She underwent a midline laparotomy, cholecystectomy and Sugarbaker repair of the parastomal hernia using a biological porcine dermal collagen mesh and remains well 5 months after surgery. Herniation of the gallbladder via a parastomal hernia is uncommon with 10 cases reported to date. While conservative and surgical measures have been applied in such cases with varying outcomes, optimal treatment remains debatable. Surgery may, however, play a role in counteracting acute complications including obstruction and inflammation. While utilising meshes for hernia repair may be a viable approach, the use of biological meshes may be preferred in a contaminated surgical field. Proper case selection is required and has to be weighed against the risks of complications and higher costs to better optimise patient outcomes.