| Author | Affiliation |
|---|---|
| Peter M. Moffett, MD | Madigan Army Medical Center, Department of Emergency Medicine, Tacoma WA |
| Bradley N. Younggren, MD | Madigan Army Medical Center, Department of Emergency Medicine, Tacoma WA |
A 23-year-old male with a history of Crohn’s disease and prior ileostomy, presented to the emergency department complaining of his “intestines coming out.” The patient reported feeling pain and a fullness in his ileostomy bag after being punched in the abdomen. The bag was removed and an evisceration of approximately two feet (60 cm) of his small intestine around the ileostomy stoma was noted (Figures 1 and and2).2). There was no evidence of strangulation, and approximately one foot of the intestines was reduced with slow pressure from a gloved finger. The remainder could not be reduced and was covered in warm, saline-soak gauze, and a surgical consult was obtained. The patient received a laparotomy with diversion of his ileostomy to his left side but did not require resection of the small bowl.
Parastomal intestinal evisceration is a rare complication with only one case report in the literature.1Rates of stoma complications vary across studies, but the most common complications are: skin irritation, necrosis, stenosis, prolapse, and parasternal hernia.2–4 While rare, this is an important complication that requires mandatory surgical consultation. Management strategies include reduction and fascial repair, or laparotomy.5
Footnotes
Supervising Section Editor: Sean Henderson, MD
Submission history: Submitted December 29, 2009; Accepted January 11, 2010
Full text available through open access at http://escholarship.org/uc/uciem_westjem
Address for Correspondence: Peter Moffett, MD, Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, WA 98431
Email pmoff2@gmail.com
Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.
REFERENCES
1. Fitzgerald JE, Tang SW, Lake EJ, et al. Small bowl evisceration: a rare complication of laparoscopic ileostomy. Colorectal Dis. 2008;10(4):407–8. [PubMed]
2. Duchesne JC, Wang YZ, Weintraub SL, et al. Soma complications: a multivariate analysis. Am Surg.2002;68(11):961–6. [PubMed]
3. Park JJ, Del Pino A, Orsay CP, et al. Stoma Complications: The Cook County Experience. Dis Colon Rectum. 1999;42(12):1575–80. [PubMed]
4. Shellito PC. Complications of Abdominal Stoma Surgery. Dis Colon Rectum. 1998 Dec;41(12):1562–72. [PubMed]
5. Nagy K, Roberts R, Joseph K, et al. Evisceration after abdominal stab wounds: is laparotomy required? J Trauma. 1999;47(4):622–6. [PubMed]
