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      Uterine tube evisceration during drainage tube removal – A rare case report

      case-report

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          Abstract

          Introduction and importance

          Drainage tubes are commonly used to remove unwanted fluid after surgery. However, they are not indicated in all situations, and there is no evidence to support their common utilization.

          Case presentation

          A 31-year-old woman at 38 weeks of gestation with a history of five cesarean sections presented with lower abdominal pain following a tonic-clonic epileptic seizure. Emergency surgery was performed due to fetal distress, and the uterus was found to be ruptured. After delivering the baby and closing the uterus, a drainage tube was inserted into the pouch of Douglas. Two days after surgery, the right ampulla and infundibulum were eviscerated from the drain site during the drainage tube removal. A second surgery was performed to reduce the herniated uterine tube.

          Clinical discussion

          Drainage tubes are typically easily removed without complications. Some reported complications related to drainage tube removal include herniation, anchoring and suctioning of the uterine tube to the drainage tube, knotting with the colonic epiploica, and fracturing and retraction of the drainage tube due to adhesions. To the best of our knowledge, this is the first reported case of uterine tube evisceration during drainage tube removal.

          Conclusion

          Evisceration after drainage tube removal is very rare. We believe that this is the first report of immediate evisceration after the removal process. Such complications can be avoided with more restricted instructions for the use of drainage tubes and more researches on the reasons for these complications.

          Highlights

          • Uterine tube evisceration after drainage tube removal is very rare.

          • This is the first report of immediate evisceration after the removal process.

          • Tube evisceration can be avoided with more restricted instructions for the use of drainage tubes.

          • More researches are needed to detect the reasons for these complications.

          Related collections

          Most cited references10

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          The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines

          The Surgical CAse REport (SCARE) guidelines were first published in 2016 as a tool for surgeons to document and report their surgical cases in a standardised and comprehensive manner. However, with advances in technology and changes in the healthcare landscape, it is important to revise and update these guidelines to ensure they remain relevant and valuable for surgeons. Materials and methods: The updated guidelines were produced through a Delphi consensus exercise. Members of the SCARE 2020 guidelines Delphi group, editorial board members, and peer reviewers were invited to participate. Potential contributors were contacted by e-mail. An online survey was completed to indicate their agreement with the proposed changes to the guideline items. Results: A total of 54 participants were invited to participate and 44 (81.5%) completed the survey. There was a high degree of agreement among reviewers, with 36 items (83.7%) meeting the threshold for inclusion. Conclusion: Through a completed Delphi consensus exercise we present the SCARE 2023 guidelines. This will provide surgeons with a comprehensive and up-to-date tool for documenting and reporting their surgical cases while highlighting the importance of patient-centred care.
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            Drain site evisceration of fallopian tube, another reason to discourage abdominal drain: report of a case and brief review of literature.

            Placement of a drain following abdominal surgery is common despite a lack of convincing evidence in the current literature to support this practice. The use of intra-abdominal drain is associated with many potential and serious complications. We report a drain site evisceration of the right fallopian tube after the removal of an intra-abdominal drain. The drain was placed in the right iliac fossa in a patient who underwent a lower segment Caesarean section (LSCS) for meconium liquor with fetal distress. The Pfannenstiel incision made for LSCS was reopened and the protruding inflamed fimbrial end of the right fallopian tube was excised. The patient made an uneventful recovery. Routine intra-abdominal prophylactic drain following an abdominal surgery including LSCS should be discouraged.
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              Laparoscopic retrieval of retained intraperitoneal drains in the immediate postoperative period

              Retained intraperitoneal Penrose drain secondary to fracture and adhesions in the immediate postoperative period happens on occasion. Most are unreported because of the fear of medico-legal problems. Previous management of such iatrogenic complications requires repeated laparotomy or wound exploration. Two patients who underwent appendectomy for ruptured appendicitis, with retained intraabdominal drains in the immediate postoperative period, managed eventually by laparoscopic retrieval are presented. Both patients had right low transverse incisions and intraabdominal drains exiting through a separate right lateral abdomen skin opening. Patient 1 had a stuck intraabdominal drain unable to be removed up to the second week. Patient 2's drain retracted intraperitoneally after its mobilization on the sixth post-op day. Both were managed by laparoscopy under general anesthesia with successful removal of both drains. Patient 1 underwent the procedure 3 weeks after the appendectomy, whereas Patient 2 had the procedure on her sixth post-op day. An additional new 1-cm wound in the periumbilical area was done for the introduction of pneumoperitoneum and 10-mm port for which the laparoscope was inserted. The second 5-mm port was inserted through the old drain site wound with peritoneal entry opening separate from the previous peritoneal defect viewed from laparoscope. Both drains had some marked adhesions from ingrowth of omentum to the side holes of the drain, causing it to get stuck in the pelvic cavity. This laparoscopic approach in the management of such iatrogenic complication, besides being cosmetically acceptable, contributes to early recovery and discharge of the patient, and helps to lessen the friction in the recently worsening doctor-patient relationship in Taiwan.
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                Author and article information

                Contributors
                Journal
                Int J Surg Case Rep
                Int J Surg Case Rep
                International Journal of Surgery Case Reports
                Elsevier
                2210-2612
                23 April 2024
                June 2024
                23 April 2024
                : 119
                : 109685
                Affiliations
                [a ]Obstetrics and Gynecology Hospital, Damascus University, Damascus, Syria
                [b ]Faculty of Medicine, Damascus University, Damascus, Syria
                Author notes
                Article
                S2210-2612(24)00466-8 109685
                10.1016/j.ijscr.2024.109685
                11078638
                38701615
                f017dc8d-9f04-4d2b-b6bc-b5571d85f148
                © 2024 The Authors

                This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

                History
                : 8 March 2024
                : 16 April 2024
                : 20 April 2024
                Categories
                Case Report

                drainage tube,evisceration,herniation,uterine tube,infundibulum,ampulla

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