Pathogenesis of peritoneal drain complications; a case report of evolving adnexal evisceration following difficult retrieval of a retained peritoneal drain

Abstract

Background: Intra-peritoneal drainage dates back to the time of Hippocrates when long bone tissue, metal, and glass tubes were employed. The benefit of routine intra-peritoneal drainage however remains debatable in contemporary times. Retained drains may be outward manifestations of more sinister or latent complications and how an entrapped surgical drain is removed, may determine the occurrence of further complications. Case Presentation: We report here the case of a 32-year-old primipara who had a retained improvised peritoneal drain, which was inserted during the cesarean section for continued oozing of serosanguineous fluid. Omental tissue found at laparoscopy, to have plugged a fenestration in the drain, was promptly relieved. A loop of the Fallopian tube was however later observed trapped in another fenestration and herniating into the stab incision of the drain tube towards the exterior, this was freed with an atraumatic laparoscopic grasper and drain tube retrieval completed under laparoscopic visualization. Conclusion: Insertion of the peritoneal drain during cesarean section should be carefully considered, when necessary; it should be done with the most appropriate drainage systems. Retrieval of the peritoneal drain is a risk factor for visceral herniation. Entrapped drains should be retrieved, under direct visualization, to prevent iatrogenic injuries.