Evisceration of gallbladder at the site of a Pezzer drain: a case report

Abstract

IntroductionThe drainage of abdominal cavity by means of tube drains is the oldest method. The herniation of gallbladder through the abdominal wall is very rare. Although there are studies informing evisceration of organs such as small intestines and ovary from drain site; at the literature scanning, no publication has been met with advising gallbladder evisceration from the Pezzer drain site so far.Case presentationWe describe here the first case in the literature of gallbladder evisceration from the Pezzer drain site. A male case with a history of operated incarcerated right inguinal hernia presented with a surgical abdomen. With a diagnosis of intestinal ischemia, the patient underwent laparotomy. About 200 cc fluid with serous quality has been determined in the abdomen and aspirated. Patchy ischemia zones were observed in ileum, over serous face. No. 30 Pezzer’s drain was placed for the intention of drainage, extending from the right side of navel towards rectovesical area. After the drainage stopped patient was discharged from hospital with recovery on the 8th postoperative day. One day after the discharge, applied to another general surgery center, by complaining that the intestine protruded through an opening in its surrounding walls of the drain place and that has been gradually enlarged. During the operation it was determined that proximal 2/3 of gallbladder has been protruded to outside of abdomen. Cholecystectomy was performed, and patient recovery was uneventful.ConclusionsGallbladder herniation is a pathology requires emergency operation.

Drain-Site Hernia Containing the Vermiform Appendix: Report of a Case

“…The stab wound was extended and appendectomy under general anesthesia performed. Even incarcerated small bowel has been described [10] or an evisceration of the gallbladder [11]. Our patient presented seven years after initial surgery with a drain-site hernia containing the vermiform appendix.…”

Laparoscopic management of a drain site evisceration of the vermiform appendix, a case report

“…Drain site evisceration is a rare complication of abdominal cavity drainage. Many organs may eviscerate through: omentum, small bowel, fallopian tube, gallbladder or vermiform appendix [1] , [2] , [3] , [4] , [5] .…”

“…This complication is often immediate after removal of the drain, but it may occur several hours or even few days later [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , even years after wound healing a drain site hernia may occur.…”

“…Its management differed from a case to another. Some authors did respect the eviscerated appendix and pulled it back into the abdominal cavity through an enlarged incision which has been closed at the end of procedure, when others performed an appendectomy through the drain site, with or without enlargement of the hole under general or local anaesthesia [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] . However, the drain defect was not closed in all cases [6] , [7] , [8] , [9] , [10] .…”

Drain Site Hernia in Adult - Case Report and Review of Literature

“…Morbidity and mortality is usually because of strangulation of the small bowel. Appendix, gallbladder have been reported as content of the drain site hernia [6] [7]. Large size of the drain (>10mm), surgical site infection, obesity, increased intraabdominal pressure, steroid administration has been prominent predisposing factors [5] [8].…”