University of California San Francisco

Parastomal Hernia

A parastomal hernia is a type of incisional hernia allowing abdominal contents to protrude through an abdominal wall defect in the stoma.

What is a Stoma

A stoma or ostomy is a surgically created opening accessible at the skin level of the abdomen allowing stool or urine to leave the body. Types of stoma include:

  • Ileostomy where the small intestine is brought to the skin, usually for diversion of stool into a bag following colon surgery
  • Colostomy where the colon is brought to the skin for collection of stool in a bag following colon or rectal surgery.

Signs and Symptoms

Parastomal hernias develop gradually and gradually increase in size. They create discomfort and are visible beneath clothes causing embarrassment. Parastomal hernias also create difficulties in attaching the stoma bag properly.

Although rare, a parastomal hernia may cause the intestine to become trapped or kinked inside the hernia causing intestinal obstruction and loss of blood supply. This is known as a strangulated hernia, a dangerous and life-threatening complication.

Diagnosis

CT scans or MRI are used to diagnose assess the extent and severity of a parastomal hernia. 

Treatment

Parastomal hernias are repaired surgically. The repair will prevent enlargement of the hernia and make the stoma easier to manage. 

Repair Options

  • When the original stoma site is no longer usable or the hernia is very large, a new stoma is created at a different site on the abdomen through an opening in healthy tissue. Moving the stoma to a new site on the abdomen is a complex operation involving removal of the original stoma from the surrounding tissue and the division of intra-abdominal scar tissue known as adhesions. 
  • Repair of the hernia is performed at the original stoma site using mesh.