The inter-observer reliability is very low at clinical examination of parastomal hernia.
BACKGROUND
Parastomal hernia in patients with a permanent colostomy is common. The aim of this study was to evaluate the reliability of the diagnosis based on clinical examination and to compare this examination with the result of a specially designed questionnaire and computerised tomography (CT) scan.


METHODS
Forty-one patients operated upon with an abdominoperineal resection due to rectal cancer at three hospitals between 1996 and 2002 were included. At minimum of 4 years after the operation, they underwent clinical examination by two or three independent surgeons, answered a colostomy questionnaire and were offered a CT scan of the abdominal wall.


RESULTS
At Hospital I, 17 patients were examined by three surgeons, with inter-observer kappa values between 0.35 and 0.64. At Hospital II, 13 patients were examined by three surgeons, the kappa values ranged between 0.29 and 0.43. At Hospital III, 11 patients were examined by two surgeons, with kappa value of 0.73. The kappa value between CT scan and the colostomy questionnaire was 0.45.


CONCLUSIONS
The inter-observer reliability was low, indicating that parastomal hernia is difficult to diagnose by patient history and clinical examination. Some herniae may not be detected by CT scan, and the correlation to patient-reported complaints is low. A more sensitive radiological method to detect parastomal hernia is needed.
Gurmu
Ambatchew
A
Department of Surgical Gastroenterology, CLINTEC, Karolinska Institutet, Stockholm, Sweden. ambatchew.gurmu@karolinska.se
Matthiessen
Peter
P
Nilsson
Sven
S
Påhlman
Lars
L
Rutegård
Jörgen
J
Gunnarsson
Ulf
U
D015992:Body Mass Index; D003125:Colostomy / Q000009:adverse effects*; D006547:Hernia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology*; D059685:Herniorrhaphy; D006801:Humans; D015588:Observer Variation; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014057:Tomography, X-Ray Computed
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