Bowel perforation caused by silicone drains: a report of two cases

We recently encountered two patients who suffered bowel perforation due to pressure necrosis caused by an open silicone drain placed in the abdominal cavity during surgery. These perforations healed spontaneously after removal of the drains from the site of perforation. Silicone drains are frequently placed in the abdominal cavity to prevent the collection of fluid or blood following surgery; however, a risk of this complication must be borne in mind. Our review of the English literature revealed eight cases of bowel perforations occurring due to a drainage system; six to closed suction drains, and two to open drainage tubes. Seven of these eight patients underwent repeat laparotomy for peritonitis, while the remaining one, who had a closed suction drain, was managed conservatively following discontinuation of the vacuum. Our experience and the literature review suggest that conservative management may be possible in patients without any signs of generalized peritonitis, although repeat laparotomy is required for those with generalized peritonitis. In conclusion, drains should be placed carefully in the abdominal cavity and removed early after the drainage has decreased.