What is Parastomal Hernia: Symptoms, Repair Technique and ICD 10 code

A parastomal hernia is best explained by initially understanding the definition of stoma. A stoma is a deliberate opening on the abdomen connecting to either the urinary tract or digestive system to allow waste to be collected from the body bypassing normal function. The stoma is covered by a pouch and is generally painless. Patients suffering from cancer of the bladder or bowel may require a temporary or permanent stoma if their bodily performance is impeded by the disease. Sufferers of Crohn’s Disease are other candidates for this procedure.

What is a parastomal hernia?

This is a recurrent outcome following either a colostomy or ileostomy. The former diverts part of the colon to the exterior of the body through a stoma and the latter, connects the ileum to an exit point on the abdominal wall. A parastomal hernia is the projection of abdominal contents through the stoma.

The challenge is that the stoma is deliberate and intentionally non-healing thus complicating any potential standard hernia repair technique. These pictures of stoma and herniated stoma illustrate the difficulties.

What are the symptoms of a parastomal hernia?

Stoma intentionally weakens the abdominal wall so out-pouching of the stoma to create a hernia is not uncommon. It may be as insignificant as a minute bulge or something large enough to be visible even through clothing. Data reveals a parastomal hernia is slightly more frequent following surgery for colostomies. Other likely causes and predispositions include cases where healing at the site is interfered with or delayed due to other factors such as pre-existing disease or even malnutrition. Obesity and the ageing process can also engender susceptibility to post-surgical complications. The symptoms of a parastomal hernia involve a discomfort ranging from mild to painful. The stoma may feel weighty or taut. Any acute pain may indicate infection, strangulation or possibly a ruptured or incarcerated (trapped) hernia requiring urgent medical attention.

What are the options for parastomal hernia repair?

Interventions can control the hernia if the symptoms are not proving too troublesome. To some extent, a parastomal hernia is a consequence that has to be tolerated whilst the stoma is present. The possibilities under review for parastomal hernia repair will depend largely on a clinical evaluation of the severity of the hernia, pain, the underlying reason for the stoma and the holistic health situation of the patient.

What is an Enterostomal Therapy nurse?

ET nurses offer specialist care and support for patients with a wide variety of issues including stoma. They assist in the management of long-term draining wounds, fistulas, incontinence and non-healing lesions such as pressure ulcers. These skilled carers are available pre-operatively to help choice of site selection and to counsel the patient in how a stoma may change their life. Following the procedure, ongoing care and advice are on side to manage complications and difficulties.

Using a support belt

Supporting the parastomal hernia with a branded surgical elasticated truss or lycra underwear can ease discomfort. There are loads of dedicated support belts for hernia but these are designed principally for people without a stoma. Specialist clinical advice should be sought to find and fit an appropriate belt which offers support for the hernia and accommodates the ostomy appliance too.

Surgical repair of a parastomal hernia

As well as being potentially unsightly, a parastomal hernia can interfere with how the stoma performs thereby impacting on bowel behaviour. Some people manage their stoma via irrigations and do not use a pouch system. This cleanses and empties the colon at designated intervals by flushing water through the mechanism. With a parastomal hernia in place, this is not always workable. A skilled surgeon can discuss different recourse. The stoma may be re-sited with the hernia repaired with a mesh or by utilising a laparoscopic repair. A local reconstruction may be possible in situ.

What does parastomal hernia icd 10 indicate?

You might have caught medial professionals discussing something called the ICD 10 code and wonder what this means. All hernias are subject to classification coding. A parastomal hernia listed as ICD10 is actually an unspecified abdominal hernia absent any gangrene or obstruction. There are myriad other codes and sub codes which cause confusion even amongst the medical profession itself.

ICD codes for parastomal hernia form part of a structure called CPT designation – Current Procedural Terminology – that evaluates and reports in simple terms the state of your parastomal hernia and the diagnostic technique and any repair to anyone who might be interested so other physicians, medical support staff and insurance companies. Any parastomal hernia, therefore, will be allocated a repair CPT code which is really only an industry-wide shorthand.

Living with stoma

There is much internet-based information and online support detailing the complexities of living with a stoma of which parastomal hernia is just one listed challenge. Stoma bags can leak causing irritation to the surrounding skin. This may just be a question of changing the appliance to create a better linkage. Patients are concerned about travelling and issues such as sexual intimacy, dietary restrictions, going back to work and even falling pregnant. Hidden from view, you would be amazed who has a colostomy bag and social media is allowing and even encouraging stoma victims to bare all, shouting from the rooftops to stamp out the stigma.

 

 

Article References:

  1. https://www.bladderandbowel.org/bowel/stoma/what-is-a-stoma/
  2. https://www.nhs.uk/conditions/colostomy/
  3. https://www.medicalnewstoday.com/articles/323240.php
  4. https://www.uptodate.com/contents/parastomal-hernia
  5. https://badgut.org/information-centre/ostomies/parastomal-hernias/
  6. https://www.ncbi.nlm.nih.gov/pubmed/1511389
  7. https://hernia-support.com/?gclid=Cj0KCQjww47nBRDlARIsAEJ34bm4tJYxDFnmpREovu5cHQo6bIe8Vhh-PVfkqEVtzMLN633ilwU4xoIaAj_tEALw_wcB
  8. https://www.medicaleconomics.com/health-care-information-technology/icd-10-training-documenting-hernia

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