Early Small Bowel Herniation through a 10-mm Port Site Immediately after Removal of a 30-Fr Pelvic Drain Following Laparoscopic Appendicectomy: A Case Report and Review of Preventive Measures

Abstract

Background: Drain-site bowel herniation is an uncommon but potentially serious postoperative complication that requires prompt recognition and timely surgical intervention. Although trocar-site hernias after laparoscopic surgery are recognised, herniation specifically through a drain site remains a distinct and rarer event. Research Gap: Immediate small bowel herniation following removal of a large-bore pelvic drain placed through a 10-mm trocar site after laparoscopic appendicectomy has been sparsely described, and preventive measures require continued emphasis. Aims: This case report aims to describe a rare case of immediate small bowel herniation through a drain site following laparoscopic appendicectomy and to discuss the mechanisms, risk factors and preventive strategies relevant to this complication. Presentation of Case: A 52-year-old man underwent laparoscopic appendicectomy complicated by an intraoperative caecal perforation, which was repaired primarily. Because of peritoneal contamination, a 30-Fr polyvinyl chloride pelvic drain was placed through the left iliac fossa 10-mm trocar site. The drain was removed on postoperative day 5 after minimal serous output. Within 30 minutes, the patient developed sudden severe pain and visible bowel protrusion through the drain site. Emergency re-exploration confirmed herniation of an approximately 8 cm viable small bowel loop through a 10–12 mm fascial defect. The bowel was reduced, and the fascial defect was closed under direct vision. Recovery following re-exploration was uneventful. Discussion: The large-bore drain probably prevented spontaneous fascial apposition, leaving a patent channel after removal through which mobile small bowel could herniate rapidly. Conclusion: Drain-site bowel herniation is rare but may progress rapidly. Avoiding large-bore drains through trocar sites, using separate drain incisions and closing all fascial defects of 10 mm or greater are important preventive measures.