A Stoma's Stowaway: A Rare Case of Parastomal Herniation of the Gallbladder.

Parastomal herniation (PSH) of visceral organs represents an exceptionally uncommon phenomenon, most often encountered in surgically complex, multimorbid patients. These cases often present significant diagnostic and surgical challenges. Involvement of the gallbladder is particularly uncommon but clinically important, due to the potential risk of complications such as cholecystitis, torsion, and perforation. We describe a case of gallbladder-containing PSH in a 76-year-old female with an extensive surgical history and ileostomy in situ. The hernia was initially managed with manual reduction, which successfully restored the gallbladder to its anatomical position. Subsequently, the patient developed gallstone pancreatitis, necessitating endoscopic retrograde cholangiopancreatography (ERCP). This report underscores the clinical uncertainty surrounding the choice between conservative and operative strategies in this high-risk cohort. Although conservative approaches may be feasible in select cases, the long-term durability of non-operative management and the risk of recurrence or delayed biliary complications remain unclear. Currently, there is no consensus on the optimal surgical management of these presentations, and decisions are guided by individual case characteristics. This report emphasises the importance of early imaging, vigilant monitoring, and a multidisciplinary approach to optimise patient outcomes.