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Mentions: An 82-year-old gentleman was admitted to our hospital for management of carcinoma of the sigmoid colon. Preoperative colonoscopy and computed tomography (CT) of the abdomen and pelvis was performed, which showed no local or distant metastasis. Laparoscopic anterior resection was performed with a 5-port technique, high ligation of inferior mesenteric vessels, and full detachment of splenic flexure. Colorectal anastomosis was performed with a double stapling technique. The mesenteric defect was left open, and the correct orientation of the anastomosis was confirmed by laparoscopy. At the end of the operation, a straight silicon French 30 drain with 3 side holes (Chimed, Italy) was inserted into the pelvis through the right iliac fossa port to drain the residual fluid after peritoneal irrigation. The drain was initially clamped to prevent air leakage. The clamp was then removed, and air vents of the trocars were opened for air decompression. On the first day after the operation, the patient was well, apart from mild abdominal distension. On the second day, he developed gross abdominal distension with a dilated small bowel on abdominal X-ray (Figure 1). A nasogastric tube was inserted for decompression of the small bowel. More than one liter of bile-stained fluid drained from the nasogastric tube everyday. On the fourth day, conservative treatment failed to resolve his intestinal obstruction. Abdominal CT revealed mechanical small bowel obstruction with an abrupt change in the caliber of the small bowel at the right iliac fossa around the drain site (Figure 2). Emergency laparoscopy was performed on the same day. A short segment of small bowel was found behind the silicon drain, and small bowel mesentery at the mesenteric border was firmly herniated into the side holes of the drain, leading to a 90-degree acute turn of small bowel in the z axis, where small bowel obstruction occurred (Figure 3). The herniated mesentery was reduced laparoscopically. The anastomosis was intact with no air leakage upon testing and the drain was removed. The patient had a period of ileus after the operation. Bowel function returned one week after the second operation, and the patient had an uneventful recovery afterwards. Histopathology report reviewed a stage 2 moderate differentiated carcinoma of the colon (T4N0M0, AJCC 5th edition).
Abdominal Drain Causing Early Small Bowel Obstruction After Laparoscopic Colectomy
Bottom Line: An 82-year-old man developed small bowel obstruction on the second day after laparoscopic anterior resection.Emergency relaparoscopy found herniation of the small bowel mesentery into the side holes of the silicon intraabdominal drain, which led to a 90-degree acute turn of the small bowel and mechanical obstruction.The herniation was reduced, and the drain was removed laparoscopically.
Affiliation: Department of Surgery, North District Hospital, Sheung Shui, Hong Kong SAR, China. firstname.lastname@example.org
We report a rare drain-related complication leading to small bowel obstruction after laparoscopic colectomy. An 82-year-old man developed small bowel obstruction on the second day after laparoscopic anterior resection. Emergency relaparoscopy found herniation of the small bowel mesentery into the side holes of the silicon intraabdominal drain, which led to a 90-degree acute turn of the small bowel and mechanical obstruction. The herniation was reduced, and the drain was removed laparoscopically.
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