Prolapsed Colostomy

A 43-year-old woman was hospitalized with a 3-day history of fever and back pain. She was malnourished and seropositive for HIV infection. Results of blood and sputum cultures were negative. A community-acquired pneumonia was diagnosed. Chest film findings and the clinical presentation were inconsistent with Pneumocystis carinii pneumonia.

During the initial physical examination, Drs Lorie F. Cram and L. Fernando Tschen of Houston found a protruding, soft, nontender mass on the left side of the woman's mid abdomen. The patient stated that the mass had been there for 6 months, and it had not caused any problems. The patient had been hospitalized 12 months earlier for a rectovaginal fistula. She underwent a diversion procedure through a loop colostomy. A few months after the surgery, the colostomy began to prolapse. An abdominal CT (A) shows the mass protruding from the abdominal cavity.

Figure B depicts the left (smaller) portion of the colostomy, the proximal or functioning part; the enlarged (right) portion is the distal, nonfunctioning part. A laparotomy and a distal sigmoid resection were performed to repair the defect. The colostomy was left in place since the patient still had a rectovaginal fistula.

Because of suspected intraperitoneal involvement, clindamycin hydrochloride was administered preoperatively. Following surgery, levofloxacin and erythromycin were given for the pneumonia.

The patient responded to the antibiotic therapy. She was discharged from the hospital 3 days after surgery and is doing well 2 months postoperatively.