Nomura T, Shirai Y, Okamoto H, Hatakeyama K
Department of Surgery, Niigata University School of Medicine, Japan.
Surg Today. 1998;28(9):940-2. doi: 10.1007/s005950050257.
We recently encountered two patients who suffered bowel perforation due to pressure necrosis caused by an open silicone drain placed in the abdominal cavity during surgery. These perforations healed spontaneously after removal of the drains from the site of perforation. Silicone drains are frequently placed in the abdominal cavity to prevent the collection of fluid or blood following surgery; however, a risk of this complication must be borne in mind. Our review of the English literature revealed eight cases of bowel perforations occurring due to a drainage system; six to closed suction drains, and two to open drainage tubes. Seven of these eight patients underwent repeat laparotomy for peritonitis, while the remaining one, who had a closed suction drain, was managed conservatively following discontinuation of the vacuum. Our experience and the literature review suggest that conservative management may be possible in patients without any signs of generalized peritonitis, although repeat laparotomy is required for those with generalized peritonitis. In conclusion, drains should be placed carefully in the abdominal cavity and removed early after the drainage has decreased.
我们最近遇到两名患者，他们在手术期间因腹腔内放置的开放式硅胶引流管导致压力性坏死而发生肠穿孔。在从穿孔部位取出引流管后，这些穿孔自行愈合。硅胶引流管经常放置在腹腔内以防止术后积液或积血；然而，必须牢记这种并发症的风险。我们对英文文献的回顾发现了8例因引流系统导致的肠穿孔病例；6例是由于封闭式吸引引流管，2例是由于开放式引流管。这8名患者中有7例因腹膜炎接受了再次剖腹手术，而其余1例使用封闭式吸引引流管的患者在停止负压吸引后采取了保守治疗。我们的经验和文献回顾表明，对于没有任何全身性腹膜炎迹象的患者，保守治疗可能是可行的，尽管对于患有全身性腹膜炎的患者需要进行再次剖腹手术。总之，应在腹腔内小心放置引流管，并在引流量减少后尽早拔除。
