The prevalence of parastomal hernia after formation of an end colostomy. A new clinico-radiological classification.
BACKGROUND
Parastomal hernia (PH) is a common complication of end colostomy, found in over 50% of patients. Abdominal computerized tomography (CT) may help diagnosis. The prevalence of PH may be higher than previously reported. We present a new CT classification for use in clinical practice.


METHODS
A cross-sectional, descriptive observational study was carried out, assessing the clinical and radiological prevalence of PH in 75 patients with an end colostomy operated on since 1997. Clinical examinations were performed by a single surgeon. Abdominal CTs were assessed by a single radiologist.


RESULTS
PH was observed clinically in 33 (44%) of 75 patients and 27 (82%) were symptomatic. Using the classification 0 (Normal), I (Hernial sac containing stoma loop), II (Sac containing omentum), III (Sac containing a loop other than stoma), radiological PH was observed in 35 (47%) patients. Clinical/radiological concordance (Kappa index = 0.4) increased proportionally with sac size. All type-III PHs (n = 9) were symptomatic. The combined prevalence of PH detected by one or other method was 60.8%.


CONCLUSIONS
Clinical and radiological prevalence of PH is high. As there is no gold standard for PH detection, we recommend a combination of the two methods. A new classification for use in clinical practice is proposed.
Moreno-Matias
J
J
Servei de Cirurgia General i del Aparell Digestiu, Corpotació Sanitaria del Parc Taulí, Sabadell, Spain. jmoreno@aecirujanos.es
Serra-Aracil
X
X
Darnell-Martin
A
A
Bombardo-Junca
J
J
Mora-Lopez
L
L
Alcantara-Moral
M
M
Rebasa
P
P
Ayguavives-Garnica
I
I
Navarro-Soto
S
S
D000368:Aged; D015331:Cohort Studies; D003125:Colostomy / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006555:Hernia, Ventral / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D015995:Prevalence; D014057:Tomography, X-Ray Computed