Massive Colostomy Prolapse with an Intrastomal Ileal Hernia: A Case Report

A 79-year-old man underwent sigmoid colostomy about 50 years previously and sought surgical reconstruction of the colostomy. He presented with 30 cm of prolapsed stoma accompanying an intrastomal hernia which contained ileum. The prolapsed stoma which led to the intrastomal hernia was made from the distal sigmoid colon, and the everted colon wall constituted the hernia sac. A computed tomography scan was useful to demonstrate the contents of the intrastomal hernia. Reconstruction with relocation of the colostomy was considered appropriate for the presented patient. The thickened and stretched distal sigmoid colon was resected with the stoma. A new end colostomy using the descending colon was seated in the left upper quadrant. The lateral pararectus muscles which formed the 8-cm hernia orifice were closed using tension-reducing incisions. The postoperative course was uneventful.