A case of simultaneous abdominal wall reconstruction and creation of diverting ostomy in a ventral hernia with loss of domain

INTRODUCTION: Diverting ostomies are traditionally used as a bridge to primary resection in patients with an obstructing mass, or severe inflammatory bowel disease [1]. In some cases, severe infections or non-healing wounds can be better managed after the diversion of fecal material away from the area [2]. In this case report, we discuss a patient who underwent a diverting loop colostomy placement through a ventral hernia defect with primary repair of the hernia in one procedure. PRESENTATION OF CASE: A 67-year-old female presented with a large, stage four sacral decubitus ulcer and an incarcerated ventral hernia. She was taken to the operating room for a transverse loop diverting colostomy through a large, pre-existing ventral hernia. The ostomy site was passed through the ventral defect at the midline. The remainder of the ventral hernia was closed primarily, and the initial incision was stapled closed. At post-operative day 11, the ostomy remained functional and intact, with no hernia recurrence, and significantly improved healing of the ulcer was seen. DISCUSSION: The large ventral hernia presented a significant obstacle during pre-operative planning. It was decided that a midline stoma was to be created simultaneously with an abdominal wall reconstruction, as any other site to bring up the ostomy would have been too far laterally. CONCLUSION: The patient was discharged in stable condition. This case presents a novel and viable method for the creation of an ostomy in patients with large ventral hernias. Further study regarding long-term outcomes may be beneficial in establishing utility.