P3687 - Incarcerated Parastomal Hernia in the Setting of Acute Rotavirus Infection in a Patient with Crohn’s Disease

Joshua Kwon, MD¹, Anastasia Chahine, MD¹, Amelie Tiritilli, MD², Jason Samarasena, MD¹, Robert Fearn, MD¹, Valery vilchez, MD^1
1University of California Irvine, Orange, CA; ²UC Irvine, Orange, CA

Introduction: Parastomal hernia formation after ileostomy is common, affecting 2-28% of end ileostomies. However, most affected patients are asymptomatic. Here we describe the case of a patient with Crohn's disease with colectomy and ileostomy creation complicated by an incarcerated parastomal hernia in the setting of an acute viral diarrheal illness.

Case Description/Methods: Patient is a 62-year-old  male with a history of Crohn’s colitis status post total colectomy with end ileostomy due to multifocal low grade colonic dysplasia. Interval ileoscopy one year post-surgically showed no evidence of active inflammatory disease and the patient was doing well without the need for immunosuppressive therapy.




He presented to our hospital with two days of acute abdominal pain, vomiting, and increased ostomy output. Initial evaluation was significant for hypovolemia, acute renal failure, metabolic acidosis, and leukocytosis. Stool studies were positive for rotavirus. Physical examination revealed prolapsed stoma with an edematous and dark appearance (Image A). Ileoscopy showed circumferential dusky grey necrotic appearing tissue extending approximately 15cm from the stoma opening (Image B). Beyond this point for another 10cm, the mucosa appeared slightly congested (Image C). 25cm from the ostomy, the mucosa was normal (Image D). Biopsies of the affected ileum showed acute inflammatory exudate but no chronic changes or dysplasia. 




CT Angiography showed distal small bowel fluid distension but no evidence of arterial abnormalities or wall thickening. His acute renal failure and hypotension improved with IV fluid resucitation. The patient was then taken to the operating room for stoma revision at which time 16cm of necrotic small bowel was removed without complication. The patient recovered well post-surgically with resolution of abdominal pain and normalization of ostomy output.

Discussion: It was believed that the high stomal output and bowel edema caused venous congestion and prolapse of the ostomy, eventually leading to strangulation and necrosis. There was no evidence of active Crohn’s disease causing bowel inflammation. In patients with ileostomies, rotavirus infection can cause severe electrolyte imbalance and increased ileostomy fluid losses. Bowel herniation and intussusception can be seen with rotavirus vaccination but not commonly with active infection. This case serves as an example of a stomal complication caused by Rotavirus infection ultimately requiring surgical intervention.



Disclosures:


Joshua Kwon, MD¹, Anastasia Chahine, MD¹, Amelie Tiritilli, MD², Jason Samarasena, MD¹, Robert Fearn, MD¹, Valery vilchez, MD¹. P3687 - Incarcerated Parastomal Hernia in the Setting of Acute Rotavirus Infection in a Patient with Crohn’s Disease, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.