A rare case of intestinal obstruction: Herniation of colon through drain site
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CASE RE PO R T
A Rare Case of Intestinal Obstruction: Herniation of Colon Through Drain Site Najmus Saadat Jamadar, Souvik Saha, Sourav Mondal, Garga Basu, Saswati Das Introduction: Abstract Herniation of abdominal viscera through drain site is not unusual. Small bowel, Appendix, Ovary, or even Gall bladder are reported as contents of these hernias with an exception of colon. We report a case presenting as acute intestinal obstruction, where the hepatic flexure of colon with omentum had been herniated through an open cholecystectomy drain site done nine years back. On emergency laparotomy, contents (hepatic flexure of colon and omentum) were reduced and found viable and parietal gap was closed from inside and reinforced with prolene mesh in preperitoneal space as well. Despite the decreasing use of intraperitoneal drains over the recent years, a multitude of patients had intraperitoneal drainage in former times. These patients face nowadays the risk of drain-site hernias with sometimes even unexpected structures inside. Key words: Intestinal obstruction; herniation of colon; drain site hernia
The usage of intraperitoneal drains has become less and less popular over the last decade, considering a variety of post-drainage complications. Possible complications are ascending infections along the tube or erosions of intraabdominal organs, such as the small intestine or the colon. Moreover, even in the absence of complications, patients with intraperitoneal drainage failed to have outcomes superior to those without drains [1,2]. Drain site hernia, though rare, is also a complication which is not to be underestimated. Herniation of Small bowel, Appendix even Gall bladder has been reported via drain site [3-5]. We report a rare case of obstructed hernia through a previous intra-abdominal drain site, with the contents being hepatic flexure of colon with omentum. Herniation of colon through drain site leading to small Najmus Saadat Jamadar, M.B.B.S, M.S. General Surgery, Clinical Tutor in Dept. of Surgery, Medical College and Hospital, Kolkata Souvik Saha, M.B.B.S, M.S. General Surgery, Medical College And Hospital, Kolkata Sourav Mondal, M.B.B.S, M.S. General Surgery, Medical College And Hospital, Kolkata Garga Basu, M.B.B.S, M.S General Surgery, Medical College And Hospital, Kolkata Saswati Das, M.B.B.S , M.D. Dermatology, Kolkata Corresponding author: Dr. Najmus Saadat Jamadar N.B.C.C, Vibgyor Tower, A-4.1, Newtown, Rajarhat, West Bengal 700156, India, Tel.: +919836016890, e-mail: [email protected] Received 06 Sept 2016; Accepted 13 Oct 2016 Hellenic Journal of Surgery 88
bowel obstruction is extremely rare and possibly scanty in surgical literature.
Case report An 82-year- old lady presented with acute intestinal obstruction with a history of open cholecystectomy by right subcostal incision and placement of drain by right lower quadrant incision 9 years earlier. Straight X-ray abdomen in erect posture (Figure 1) revealed features of small bowel obstruction, for which she undergone emergency midline laparotomy. La
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