背景:由插入引流管引起的回肠穿孔是一种罕见的并发症。因此,在腹部手术中使用外科引流管仍存在争议。目前,在腹部手术中有减少引流管使用的趋势,尽管某些情况可能需要它们的应用。
方法:一名25岁的中国女性,有右下腹痛持续10天的病史。影像学检查,包括腹部计算机断层扫描和超声检查,发现右下腹部10×8×8cm3的低密度病变,与穿孔性阑尾炎并发阑尾周围脓肿一致。进行了腹腔镜阑尾切除术。术后第5天,引流液变为草绿色(80mL)。通过引流管进行逆行对比成像显示,26Fr硅橡胶引流管尖端位于回肠内回肠连接处50cm处。回肠和回盲区都发育良好。
结果:暂停口服摄入,病人接受了抗酸剂,生长抑素,抗生素,和全胃肠外营养。术后第19天,通过引流管使用逆行造影的随访成像程序显示导管尖端已密封.治疗在术后第33天结束,病人出院了.
结论:腹腔镜阑尾切除术后由于腹腔引流管而导致的回肠穿孔是一种罕见但严重的并发症。然而,由于脓肿周围的粘连和炎症变化,腹腔镜解剖成为一个具有挑战性和风险的过程,手术技巧和经验尤为重要。建议根据引流液的特点及时取出腹腔引流管。这些发现为外科医生应对类似挑战提供了有价值的见解。
BACKGROUND: Ileal perforation caused by the insertion of a drainage tube is a rare complication. Hence, the utilization of surgical drains in abdominal surgery remains controversial. At present, there is a trend to reduce the utilization of drains in abdominal surgery, although certain situations may necessitate their application.
METHODS: A 25-year-old Chinese woman presented with a history of right lower abdominal pain persisting for 10 days. Imaging examinations, including abdominal computed tomography and ultrasound, identified low-density lesions measuring 10 × 8 × 8cm3 in the right lower abdomen, which are consistent with perforated appendicitis complicated by a peri-appendiceal abscess. A laparoscopic appendectomy was carried out. On the 5th postoperative day, the drainage fluid changed to a grass-green color (80mL). Imaging with retrograde contrast through the drainage tube revealed that the 26 Fr silicon rubber drainage tube tip was positioned 50cm away from the ileocecal junction within the ileum. Both the ileal and ileocecal regions appeared well-developed.
RESULTS: Oral intake was suspended, and the patient received antacids, somatostatin, antibiotics, and total parenteral nutrition. On the 19th postoperative day, a follow-up imaging procedure using retrograde contrast through the drainage tube indicated that the tube tip was sealed. The treatment concluded on day 33 postoperatively, and the patient was discharged.
CONCLUSIONS: Ileal perforation due to an abdominal drainage tube following laparoscopic appendectomy constitutes a rare but serious complication. However, due to the adhesion and inflammatory changes around the abscess, laparoscopic dissection becomes a challenging and risky process, and the surgical skills and experiences are particularly important. Removing the abdominal drainage tube promptly based on the characteristics of the drainage fluid is recommended. The findings provide valuable insights for surgeons navigating similar challenges.