A case of unusual evisceration through laparoscopic port site

Abstract

Drain site eviscerations have been reported as a rare complication following abdominal surgery. An 82-year-old women was diagnosed with carcinoma stomach and underwent laparoscopic subtotal gastrectomy. A few hours following removal of the duodenal stump drain, she developed small bowel evisceration through the drain site. It was successfully managed with immediate bedside release of fascial constriction followed by definitive repair later. Although herniations and eviscerations via larger drain sites have been reported, eviscerations from small laparoscopic port sites used for drains are rare. Here, we report the first case of small bowel evisceration with strangulation through a 5-mm port site.

Drain-site hernia after laparoscopic rectal resection: A case report and review of literature

“…However, there are rare reports of DSH at the 5 mm port site. Moreaux et al [ 13 ] and James et al [ 14 ] reported cases which occurred at the 5 mm port site from several hours to several days after the drainage tube was removed. These cases were largely caused by the suction effect resulting from drain removal and a postoperative complication ( e.g.…”

Evisceration of a Small Bowel Segment Through a Drain Site: Lesson Learnt

“…These were the omentum, gallbladder, appendix vermiformis, fallopian tube, and small bowel. In the aforementioned cases, evisceration occurred three to eight hours post-operation [2,[6][7][8]11,14]. Drain site eviscerations along with the drain have not yet been reported as a complication following open abdominal or laparoscopic surgery.…”

“…Due to the imminent risk of strangulation and subsequent necrosis of the eviscerated organ, drain site evisceration requires immediate intervention. Mathew et al proposed a bedside reduction of the strangulated, ischemic small bowel under local anaesthesia after extending the drain site incision and simultaneous resuscitation with warm gauze and 100% oxygen [2]. Spartalis et al performed, on an urgent basis, a bedside appendectomy under sterile conditions, without anaesthesia or extending the drain site incision [15].…”

“…Intra-abdominal drainage systems are a common postoperative part of any emergency surgical operation. They prevent the collection of blood and infected fluids and the formation of an abscess, identify any anastomotic leakage, and contribute to the healing process [1][2][3]. Drain site complications are rare and include evisceration, herniation, haemorrhage, hollow viscus perforation, infection at the site, fistula formation, and kinking and knotting of drains [1,2,4,5].…”

“…They prevent the collection of blood and infected fluids and the formation of an abscess, identify any anastomotic leakage, and contribute to the healing process [1][2][3]. Drain site complications are rare and include evisceration, herniation, haemorrhage, hollow viscus perforation, infection at the site, fistula formation, and kinking and knotting of drains [1,2,4,5]. Organs such as the omentum, gallbladder, appendix vermiformis, and small bowel have been reported that they can be eviscerated through a drain site [6][7][8].…”