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Case report and operative management of gallbladder herniation.

To H, Brough S, Pande G - BMC Surg (2015)

Bottom Line: This rare diagnosis is often not considered and, when diagnosed, has a different management approach.The experience of the small number of case reports have yet to be collected and summarised.We report a presentation and management of an 85 year old Caucasian female with a gallbladder hernia into a parastomal defect, and outline the operative management.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia. henry.to@mh.org.au.

ABSTRACT

Background: Incarcerated abdominal wall hernias may contain a variety of contents, but very rarely contains the gallbladder. This rare diagnosis is often not considered and, when diagnosed, has a different management approach. The experience of the small number of case reports have yet to be collected and summarised.

Case presentation: We report a presentation and management of an 85 year old Caucasian female with a gallbladder hernia into a parastomal defect, and outline the operative management.

Conclusion: Incarcerated gallbladder hernia is an extremely unusual condition, best diagnosed by CT scan. Management should involve operative reduction, cholecystectomy and consideration of repair of the defect.

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Identification of parastomal defect at laparotomy demonstrating the gallbladder neck
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Fig3: Identification of parastomal defect at laparotomy demonstrating the gallbladder neck

Mentions: At operation on the same day, a urinary catheter was placed in the stoma, and a midline laparotomy was performed. Following dissection and reduction of the midline abdominal hernia, the parastomal defect was defined (Fig. 2). A 14 gauge needle was used to drain the hernia contents of which bile was extracted, confirming the presence of the gallbladder in the hernia (Fig. 3). The gallbladder was then able to be reduced, and noted to be acalculous but thick walled and oedematous (Fig. 4). A cholecystectomy was performed. The large remaining parastomal defect was not closed to not risk the blood supply to the ileal conduit. The patient had an uneventful post-operative course and was discharged on day five. She was well at her one month follow up. Histopathology of the specimen showed chronic cholecystitis without carcinoma.Fig. 2


Case report and operative management of gallbladder herniation.

To H, Brough S, Pande G - BMC Surg (2015)

Identification of parastomal defect at laparotomy demonstrating the gallbladder neck
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4464702&req=5

Fig3: Identification of parastomal defect at laparotomy demonstrating the gallbladder neck
Mentions: At operation on the same day, a urinary catheter was placed in the stoma, and a midline laparotomy was performed. Following dissection and reduction of the midline abdominal hernia, the parastomal defect was defined (Fig. 2). A 14 gauge needle was used to drain the hernia contents of which bile was extracted, confirming the presence of the gallbladder in the hernia (Fig. 3). The gallbladder was then able to be reduced, and noted to be acalculous but thick walled and oedematous (Fig. 4). A cholecystectomy was performed. The large remaining parastomal defect was not closed to not risk the blood supply to the ileal conduit. The patient had an uneventful post-operative course and was discharged on day five. She was well at her one month follow up. Histopathology of the specimen showed chronic cholecystitis without carcinoma.Fig. 2

Bottom Line: This rare diagnosis is often not considered and, when diagnosed, has a different management approach.The experience of the small number of case reports have yet to be collected and summarised.We report a presentation and management of an 85 year old Caucasian female with a gallbladder hernia into a parastomal defect, and outline the operative management.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia. henry.to@mh.org.au.

ABSTRACT

Background: Incarcerated abdominal wall hernias may contain a variety of contents, but very rarely contains the gallbladder. This rare diagnosis is often not considered and, when diagnosed, has a different management approach. The experience of the small number of case reports have yet to be collected and summarised.

Case presentation: We report a presentation and management of an 85 year old Caucasian female with a gallbladder hernia into a parastomal defect, and outline the operative management.

Conclusion: Incarcerated gallbladder hernia is an extremely unusual condition, best diagnosed by CT scan. Management should involve operative reduction, cholecystectomy and consideration of repair of the defect.

Show MeSH
Related in: MedlinePlus