Postoperative hemoperitoneum and inefficient suction drain

After any major procedure, bleeding into the abdominal cavity or from the abdominal wound is possible. This complication is unusual because of the precautions that are taken, but when important bleeding happens, it may be necessary to return to the operating room. Drainage tubes are often used for monitoring after an operation to allow secretions or blood to come away. It is very important to select the appropriate type of drain for each procedure. This video is presented in order to demonstrate the poor benefit of a suction drain in case of postoperative abdominal complications.

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Postoperative hemoperitoneum and inefficient suction drain

Authors

D Mutter, J Marescaux

Abstract

After any major procedure, bleeding into the abdominal cavity or from the abdominal wound is possible. This complication is unusual because of the precautions that are taken, but when important bleeding happens, it may be necessary to return to the operating room. Drainage tubes are often used for monitoring after an operation to allow secretions or blood to come away. It is very important to select the appropriate type of drain for each procedure. This video is presented in order to demonstrate the poor benefit of a suction drain in case of postoperative abdominal complications.

Classification

tips and tricks

Keywords

Postoperative hemoperitoneum, inefficient suction drain

Media type

Surgical video

Duration

01'05''

Publication

2009-07

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E-publication

WeBSurg.com, Jul 2009;9(07).
URL: http://www.websurg.com/doi-vd01en2624.htm

Postoperative hemoperitoneum and inefficient suction drain

1. Introduction 00'07''

In order to demonstrate the poor benefit of a suction drain in case of postoperative complications, we report the case of a 73-year-old female patient presenting with tachycardia, pallor and abdominal pain 72 hours after a laparoscopic sigmoidectomy. Biochemistries show hemoglobin at 6g/dL. The patient is urgently admitted to the operating room for a redo.

2. Intra-abdominal exploration 00'35''

The exploration helps to immediately identify the presence of a massive hemoperitoneum.

3. Identification of bleeding source 00'44''

A source of bleeding is found. There is a bleeding at one of the trocar sites used to perform the sigmoidectomy. The abdominal exploration is continued laparoscopically with attempts at suctioning of all the clots and blood out of the peritoneal cavity.

4. Suction drain removal 01'10''

The suction drain placed during the sigmoidectomy is removed. It becomes evident that this drain is not only ineffective when it comes to suctioning the blood ooze, it also turns out to be dangerous, as can be seen here where it aspirates the serosa of the small bowel at the level of its suction holes. These are progressively freed, allowing for a complete removal of the suction drain. A suction drain such as the one we can see here, must not be placed intraperitoneally, only subperitoneally. Not only will it not aspirate a postoperative haemorrhage, it can also harm the bowel. As soon as the suction drain is removed, a lavage of the entire abdominal cavity is envisaged. However, the presence of a 2 litre hemoperitoneum and the density of the clots does not allow for a complete emptying of the peritoneal cavity, nor to ensure that the etiology of bleeding has been identified with certainty. A conversion to laparotomy is decided upon. This will ensure that all the blood clots are removed out of the abdominal cavity. More than 2 litres of blood will be suctioned out. This will also rule out any other existing causes of bleeding. The postoperative outcome is uneventful and the patient is discharged on the 8th postoperative day.