Intraoperative Discovery of an Unintentionally Retained Abdominal Drain Fragment Incorporated Into the Small Bowel...

Retained surgical items are extremely rare but significant critical complications of abdominal surgery. These complications are usually associated with considerable morbidity and medicolegal implications. Among these, retained surgical drains are especially uncommon and often underreported. We present a case of an incidental intraoperative discovery of a retained abdominal drain fragment during elective colostomy reversal. Here, we present the case of a 40-year-old male who underwent elective reversal of a sigmoid loop colostomy, which had been created 10 months earlier following a penetrating abdominal stab injury. The patient remained asymptomatic during the interim period, with no clinical or radiological suspicion of intra-abdominal pathology. During surgery, dense adhesions were encountered, and a retained fragment of an abdominal drain kit was identified embedded within a fibrous tract. Further exploration revealed a 2 × 1 cm ileal perforation, which had been effectively sealed by the incorporated drain segment, preventing peritoneal contamination. The drain had also eroded proximally into the jejunum and distally into the anterior abdominal wall. The foreign body was carefully removed, the perforation was repaired, and the patient had an uneventful postoperative recovery. Unlike previously reported cases of retained surgical drains, which typically present with infection, obstruction, or fistula within weeks to months of retention, this case is notable for a 10-month asymptomatic interval, attributable to the drain fragment's dual role in both causing and simultaneously sealing the bowel perforation. This case highlights an unusual presentation in which a retained drain fragment appeared to function as a biological seal over the perforation site, likely accounting for the prolonged asymptomatic course.