Prevention is Better than Cure: Intra-abdominal Migration of Drain Placed for Bile Duct Injury : Journal of Emergencies, Trauma, and Shock

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Prevention is Better than Cure

Intra-abdominal Migration of Drain Placed for Bile Duct Injury

Bodda, Arvind Kumar; Srividya, Bhargavi; Kumar, Pankaj

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Journal of Emergencies, Trauma, and Shock: Jul–Sep 2022 - Volume 15 - Issue 3 - p 153-154
doi: 10.4103/jets.jets_6_22
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Dear Editor,

Only a few cases of intra-abdominal migration of the surgical drain have been reported.[12] The migration of these vital drains adds to significant morbidity and can lead to catastrophic consequences if left unattended.[2] A 26-year-old female presented to the emergency with diffuse pain abdomen following slippage of the surgical drain into the abdominal cavity. After a bile duct injury was detected, a 28-F PVC drain was placed in the right subhepatic region during laparoscopic cholecystectomy. Because we planned for a delayed bile duct injury repair, the patient was discharged with the drain still in place. The drain was cut short, and a stoma bag was applied. During this admission, a computed tomography scan was done to accurately localize the drain and intra-abdominal collection [Figure 1a and b]. The patient did not consent for relaparoscopy, considering her prior lousy experience with laparoscopy. Even though the drain was removed via exploratory laparotomy, the patient was forced to undergo an unwelcome surgery [Figure 1c]. Drain migration has been linked to four theories: failure to properly fix the drain, cutting through the suture around the drain, low abdominal pressure, and putting the body weight over the drain.[1] Previous reports have shown pressure necrosis of neighboring tissues, hemorrhage, perforation, fistulization, drain site hernia, mechanical intestinal blockage, and drain site infection.[12] Intraluminal drain migration, drain passage during defecation, laparoscopic removal of intra-abdominal drain owing to “drain fracture,” and Robinson tube (24F) drain migration are some of the uncommon events described.[3456] Most of the instances recorded so far have involved Penrose and Jackson–Pratt drains.[1] The migration of a 28-F PVC drain tube in the abdominal cavity 3 weeks after surgery made our case distinctive. This unusual phenomenon can be explained in our case by cutting the drain short and failing to reattach/reinforce the drain with a new suture. We implemented a protocol of observing the trainees during intraoperative drain fixation. We cannot really comment on cutting the drain short because there are no recommendations, but we do not think it is a wise decision. Before sending the patient home, we recommend securing the drains twice with sutures.

F1-10
Figure 1:
CT scan showing intrabdominal drain(a and b); drain after surgical removal(c)

Research quality and ethics statement

The authors followed applicable EQUATOR Network (https://www.equator-network.org/) guidelines, notably the CARE guideline, during the conduct of this report.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

REFERENCES

1. Radhakrishna V, Tanga SM. Lesson learnt from a migrated drain: A case report Ann Med Surg (Lond). 2017;20:80–3
2. Loh A, Jones PA. Evisceration and other complications of abdominal drains Postgrad Med J. 1991;67:687–8
3. Carlomagno N, Santangelo ML, Grassia S, La Tessa C, Renda A. Intraluminal migration of a surgical drain.Report of a very rare complication and literature review Ann Ital Chir. 2013;84:219–23
4. Pazouki A, Toolabi K, Zahedi Shoolami L, Fanaii SA, Vaziri M. Penrose Drain Migration After Laparoscopic Surgery Acta Med Iran. 2009;47:159–60
5. Liao CS, Shieh MC. Laparoscopic retrieval of retained intraperitoneal drains in the immediate postoperative period J Chin Med Assoc. 2011;74:138–9
6. Hanchanale V, Rao AR, Laniado M, Karim O. Disappearing drain – Disaster averted and lesson learnt! N Z Med J. 2007;120:U2496
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