Perforation of the bowel by suction drains

Fatal Biliary Peritonitis Due to Postinsertion Migration of a Robinson Drain Tip, With Erosion Into the Liver Parenchyma

Iatrogenic injury due to incorrectly sited drains and tubes is a rare but recognized complication and can occur at many different sites. Migration of correctly sited drains and tubes is rarer still. A handful of rare cases involving longstanding ventriculoperitoneal and lumboperitoneal shunts migrating and causing perforation of the bowel exist, often complicated by central nervous system sepsis. We present a previously unreported complication of a Robinson drain, one of 2 abdominal drains inserted under direct vision during a subtotal gastrectomy for carcinoma, in a frail 78-year-old woman. Twenty-four days postoperatively, after a period of predictably slow but steady recovery, bile-stained fluid was noted in the drain. Unfortunately, the patient rapidly deteriorated and died. Autopsy revealed multiorgan failure due to peritonitis. Both drains were noted to be correctly and firmly sutured to the skin. The tip of the right-sided Robinson drain was found to have migrated, eroding into the liver parenchyma, resulting in biliary peritonitis. The left-sided Robinson drain was correctly sited in the peritoneal cavity. We present the postmortem findings and a review of the literature.

Optional sump: novel use of triple lumen closed drainage system

BACKGROUND

The debate over the use of drains in abdominal surgery is controversial. Selective drainage using a closed system is the method employed by most surgeons. There are, however, specific circumstances where different forms of drainage are required.

METHODS

One hundred and sixty-seven patients undergoing a mix of complex upper gastrointestinal surgery and colorectal surgery received an Axiom sump drain at the time of surgery. All side air vents were spigoted and the main lumina connected to a urine bag, with the option to convert to irrigation/suction as required.

RESULTS

Two patients required conversion to irrigation/suction, because of ongoing egress of fluid. In both cases drainage ceased without surgical intervention. The remaining cases resolved with no complications related to the drain.

CONCLUSION

The technique described allows the use of a large bore, soft, gravity-driven drain in cases where wound drainage is necessary. The closure of the ventilation ports maintains the advantage of a closed drainage system, yet allows for the conversion to a true sump system as required. This obviates the need for further drainage procedures.

Complications associated with suction drains after microvascular anastomeses

Two head and neck cases in which free flaps were used for reconstruction are presented. The circulation of the flaps was compromised due to problems directly associated with suction drains. The methods of drain fixation are discussed.