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Published on: February 20, 2017
Abdominal drain straying into right atrium: a case report
Junya Toyoda1,2, Hitoshi Sekido3, Kazuhisa Takeda3
1Department of Surgery, National Hospital Organization Yokohama Medical Center, 3-2-60, Harajuku, Totuka-Ku, Yokohama, Kanagawa, 245-8575, Japan. toynuj@gmail.com.
Insights
Drain exchange complications can be serious. Careful guidewire use during drain exchanges is crucial to prevent accidental placement into blood vessels, avoiding severe patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Interventional Radiology
Background:
- Drain exchange procedures, particularly with guidewire assistance, carry inherent risks of serious complications.
- Accurate drain placement is critical in managing postoperative complications like bile leakage.
Purpose of the Study:
- To report a rare case of drain misplacement into the right atrium during a complicated drain exchange.
- To highlight the potential for severe vascular complications following abdominal drain manipulation.
Main Methods:
- A case presentation of an 86-year-old male with complex cholangiocarcinoma undergoing hepatectomy and bile duct reconstruction.
- Multiple drain exchanges were performed due to persistent bile leakage.
- Imaging (CT, echocardiography) and surgical interventions were used to diagnose and manage complications.
Main Results:
- The abdominal drain migrated into the right atrium, necessitating removal from the inferior vena cava.
- A subsequent thrombus formation from the inferior vena cava to the right atrium was identified.
- Surgical intervention for thrombus removal and vessel repair led to patient recovery.
Conclusions:
- Guidewire manipulation during drain exchange requires meticulous attention to avoid intravascular placement.
- Vigilance in monitoring drain position and potential complications is essential in postoperative care.
- Preventing drain misplacement can avert life-threatening vascular events.
Background:
A drain exchange with the use of a guidewire may be accompanied by serious complications.
Case Presentation:
This case involved an 86-year-old man with overlapping cancers of intrahepatic cholangiocarcinoma and perihilar cholangiocarcinoma. A left hepatectomy, a left caudal lobectomy (with a medial hepatic vein preservation), an extrahepatic bile duct resection, and a right hepatojejunostomy were performed. The abdominal drain was placed into the hepatectomy side. Bile leakage occurred on the seventh day after the surgery, and the drain was exchanged. Since the bile leakage was still detectable via a computed tomography (CT) scan on the 15th postoperative day, the drain was exchanged again. On the next day, blood had discharged from the drain. A CT scan revealed that the tip of the drain was straying into the right atrium (RA) and the drain was removed from the inferior vena cava (IVC) under general anesthesia. One week later, a fiburin thrombus was observed from the IVC to the RA via the use of transthoracic echocardiography. A right atrial incision, a thrombus removal, and a middle hepatic vein merging section closure surgery were performed. Afterward, the patient's general condition gradually improved, and he was transferred to the hospital for rehabilitation.
Conclusion:
More careful guidewire operations are necessary at the time of the exchange of the drain to prevent the drain from being placed too close to blood vessels.
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