Lesson learnt from a migrated drain: A case report

Abstract

IntroductionThough surgical drainage is used as a safety measure, it's not without complications. Migration of various drains has been described, but very little literature refers to the migration of peritoneal drain.Presentation of caseA 55-year male underwent anterior Gastro-Jejunostomy for inoperable metastatic carcinoma of the Gastric Pylorus. We found the peritoneal drain missing on the third post-operative day. On further evaluation, we found it to have migrated into the peritoneal cavity. We opened the operative wound for a partial length and retrieved the drain.DiscussionWe did research to find why drain migrates and searched literature on migration of peritoneal drains. The possible etiologies for drain migration are (1) Drain hasn't been fixed properly (2) Cutting through of suture material (3) Relatively low abdominal pressure (4) Pressure over the drain by patient's body weight when he lies on the same side as drain.ConclusionEvery use of drain should be weighed for its needs and risks. Proper precautions during drain placement avoid unnecessary complications, morbidity and prolonged hospital stay.

Review of the use of prophylactic drain tubes post‐robotic radical prostatectomy: Dogma or decent practice?

“…DT’s can sometimes induce an anastomotic leak due to mechanical, negative pressure, or suction effect when the DT is overlying the anastomosis 12 . DT’s have also been reported to be retained within body cavities and a second procedure to remove the DT or retrieve a foreign body is sometimes necessary 13,14 . Another recognized disadvantage of DT’s pertains to a lack of clarity regarding the appropriate type of DT to be employed in particular situations and the duration of drainage required.…”

To use indwelling drainage or not in dual-plane breast augmentation mammoplasty patients

“…[ 6 – 8 ] Moreover, vacuum drainage may also cause tube-related tissue injury or hematoma formation, [ 9 ] foreign body-related infection, [ 10 , 11 ] blockage, [ 12 ] and migration. [ 13 , 14 ] Discomfort and pain may also be associated with a thick drain tube. [ 15 – 17 ] In Khan's study, [ 18 ] there was limited evidence available demonstrating no significant benefit of using postoperative wound drainage in reduction mammoplasty.…”

Prevention is Better than Cure

“…Only a few cases of intra-abdominal migration of the surgical drain have been reported. [ 1 2 ] The migration of these vital drains adds to significant morbidity and can lead to catastrophic consequences if left unattended. [ 2 ] A 26-year-old female presented to the emergency with diffuse pain abdomen following slippage of the surgical drain into the abdominal cavity.…”

“…Drain migration has been linked to four theories: failure to properly fix the drain, cutting through the suture around the drain, low abdominal pressure, and putting the body weight over the drain. [ 1 ] Previous reports have shown pressure necrosis of neighboring tissues, hemorrhage, perforation, fistulization, drain site hernia, mechanical intestinal blockage, and drain site infection. [ 1 2 ] Intraluminal drain migration, drain passage during defecation, laparoscopic removal of intra-abdominal drain owing to “drain fracture,” and Robinson tube (24F) drain migration are some of the uncommon events described.…”

“…[ 1 ] Previous reports have shown pressure necrosis of neighboring tissues, hemorrhage, perforation, fistulization, drain site hernia, mechanical intestinal blockage, and drain site infection. [ 1 2 ] Intraluminal drain migration, drain passage during defecation, laparoscopic removal of intra-abdominal drain owing to “drain fracture,” and Robinson tube (24F) drain migration are some of the uncommon events described. [ 3 4 5 6 ] Most of the instances recorded so far have involved Penrose and Jackson–Pratt drains.…”