Department of General Surgery, Jiaozhou Branch of Shanghai East Hospital, Tongji University, Qingdao, China.
State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Beijing, China.
Medicine (Baltimore). 2024 Jun 7;103(23):e38405. doi: 10.1097/MD.0000000000038405.
Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains controversial. At present, there is a trend to reduce the utilization of drains in abdominal surgery, although certain situations may necessitate their application.
A 25-year-old Chinese woman presented with a history of right lower abdominal pain persisting for 10 days. Imaging examinations, including abdominal computed tomography and ultrasound, identified low-density lesions measuring 10 × 8 × 8cm3 in the right lower abdomen, which are consistent with perforated appendicitis complicated by a peri-appendiceal abscess. A laparoscopic appendectomy was carried out. On the 5th postoperative day, the drainage fluid changed to a grass-green color (80mL). Imaging with retrograde contrast through the drainage tube revealed that the 26 Fr silicon rubber drainage tube tip was positioned 50cm away from the ileocecal junction within the ileum. Both the ileal and ileocecal regions appeared well-developed.
Oral intake was suspended, and the patient received antacids, somatostatin, antibiotics, and total parenteral nutrition. On the 19th postoperative day, a follow-up imaging procedure using retrograde contrast through the drainage tube indicated that the tube tip was sealed. The treatment concluded on day 33 postoperatively, and the patient was discharged.
Ileal perforation due to an abdominal drainage tube following laparoscopic appendectomy constitutes a rare but serious complication. However, due to the adhesion and inflammatory changes around the abscess, laparoscopic dissection becomes a challenging and risky process, and the surgical skills and experiences are particularly important. Removing the abdominal drainage tube promptly based on the characteristics of the drainage fluid is recommended. The findings provide valuable insights for surgeons navigating similar challenges.
引流管插入导致的回肠穿孔是一种罕见的并发症。因此，腹部手术中引流管的使用仍然存在争议。目前，尽管某些情况下可能需要应用引流管，但腹部手术中减少引流管使用的趋势正在出现。
一名 25 岁的中国女性，因右下腹痛持续 10 天就诊。腹部 CT 和超声等影像学检查发现右下腹部有 10×8×8cm3 的低密度病变，符合穿孔性阑尾炎合并阑尾周围脓肿。行腹腔镜阑尾切除术。术后第 5 天，引流液变为草绿色（80mL）。经引流管逆行造影发现 26Fr 硅橡胶引流管尖端位于回肠内距回盲部 50cm 处。回肠和回盲部均发育良好。
暂停经口进食，给予抗酸剂、生长抑素、抗生素和全胃肠外营养。术后第 19 天行引流管逆行造影复查，示管尖端堵塞。术后第 33 天治疗结束，患者出院。
腹腔镜阑尾切除术后腹部引流管导致的回肠穿孔是一种罕见但严重的并发症。但由于脓肿周围的粘连和炎症改变，腹腔镜下解剖成为一个具有挑战性和风险的过程，手术技巧和经验尤为重要。根据引流液的特点，建议及时取出腹腔引流管。该病例为外科医生处理类似挑战提供了有价值的参考。
