Bedside radionuclide scanning in the postoperative management of intraperitoneal sump drains

The volume of the peritoneal cavity opacificable by the instillation of 99mTechnetium labeled albumin through a sump drain was studied over successive postoperative days in 19 patients (21 drains) using a portable gamma camera. After operation, a constant gravity drip of saline solution was delivered through the sump "in" port. The "out" port was connected to low constant suction. Encapsulation (opacification of only the catheter) was demonstrated in eight of the catheters on either the initial study (six) or on successive (two) studies. This encapsulation was demonstrated sometime between the first and sixth postoperative day. The volume of the peritoneal cavity which was perfuseable did decrease measurably over several successive days in three of the patients. In nine of 21 drains, a significant volume of the peritoneal cavity was still perfuseable on the third and up to the sixth postoperative day. The classic teaching that a drain placed in the peritoneal cavity promptly encapsulates may apply to static gravity drains but does not apply to perfused sump drains used in this study. The manner in which fluid is instilled may modify the volume of peritoneal cavity perfused. The 99mTechnetium labelled albumin technique is suitable for bedside use because of its simplicity and lack of adverse reactions. Its accuracy facilitates the decision as to when a sump drain should be removed.