Delayed Small Bowel Obstruction Due to Intra-Abdominal Drain: Case Report and Literature Review

Abstract

This is a unique case of a closed-loop bowel obstruction secondary to intra-abdominal drain insertion to illustrate a new complication of drain usage. A 47-year-old patient presents with bowel distention and obstruction. Laparotomy revealed obstructed small bowel looped around a fibrotic tract tracing back to a drain insertion point. This is a case report where a patient suffers rare long-term complications from routine drain insertion. Although beneficial in treating infection and abscess formation after anastomotic leaks, drain insertion as a prophylactic measure has not been proven to be beneficial. Surgeons who routinely use intra-abdominal drains should be aware of the complications of drain insertion and use with caution. Although not extensively documented, serious complications from drain insertion do occur. There is no role for prophylactic drain insertion in colonic anastomoses procedures.

Early Small Bowel Obstruction Caused by Surgical Drain Following Rectal Cancer Surgery: A Case Report

“…Indeed, surgical drains aid in the earlier detection for better management of complications, and leakage of surgical anastomoses [ 1 , 5 ]. However, it should be noted that several complications of drain usage may lead to significant morbidity and mortality (17%) [ 1 , 8 , 9 ].…”

“…Furthermore, the literature has frequently reported the risk of surgical site infections caused by drains, in addition to other complications that have been described such as small bowel evisceration, bronchoperitoneal fistula, and bowel perforation from pressure necrosis [ 4 , 5 , 10 ]. Acute bowel obstruction due to drains remains very uncommon and should be considered, and distinguished from postoperative ileus, in patients with surgical drains presenting post-operative nausea and distention [ 5 , 8 ]. Shah et al described the phenomenon of the obstruction as a “maypole” effect, the vacuum effect of the drain can lead to obstruction [ 11 ].…”

Is Prophylactic Abdominal Drainage Necessary After Laparoscopic Colectomy For Colon Cancer? A Propensity Score-Matched Analysis

“…Whether the drainage tube causes intestinal obstruction is still unclear, but this complication was mentioned before. [4,16] In addition, routine drainage can cause other problems such as pain, discomfort and limitation of returning to normal activities of the patients.…”

Early post‐operative small bowel obstruction from surgical drain compression

“…A Cochrane study of six randomised controlled trials comparing patients with prophylactic drains and patients without revealed no significant variance in mortality, anastomotic dehiscence, wound infection or other complications. 12 EPSBO is a rare complication that can arise from surgical drain placement, amongst other causes. It is essential to recognise this rare but important cause of EPSBO to prevent more sinister consequences.…”

“…A Cochrane study of six randomised controlled trials comparing patients with prophylactic drains and patients without revealed no significant variance in mortality, anastomotic dehiscence, wound infection or other complications 12 …”