Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 64, Num. 6, 2002, pp. 537-538

Indian Journal of Surgery, Vol. 64, No. 6, Nov - Dec. 2002, pp. 537-538

Letter to the Editor

Evisceration of Appendix Through Abdominal Drainage Site

Dr Pradeep Sharma

6 & 7 Pramila Apartments, 93, Sahaney Sujan Park, Lullanagar, Pune 411 040, Email: geetanjali-ip@eth.net

Code Number: is02018

Sir,

This has reference to the article "Evisceration of appendix through abdominal drainage site" published in the Indian Journal of Surgery recently.¹

This interesting case report has very vividly covered the literature available on the complication of evisceration but lacks the explanation of the mechanism of this evisceration and what can be done to avoid it. Evisceration is a complication, the treatment of which may involve a manoeuvre as simple as pushing the eviscerated organ back into the abdominal cavity through the drain site to another surgical procedure with its attendant morbidity.

The intra-abdominal pressure under the normal circumstances is negative. When the abdomen is opened, this pressure becomes positive and remains so in the first few days till the air is absorbed. In the postoperative period this positive pressure tends to push the intra-abdominal structures, most often omentum or fat, into the openings of drainage tubes. This is aided by the peristaltic waves and gravity - factors beyond direct control.

What can be done to avoid this complication? First and foremost is to milk the tube drains inward every day. This would prevent the clogging of drain by the fibrin plugs and thus help reduce collection. Secondly, it would also prevent the intra-abdominal structures from adhering to the drains. It has been found that the process of adhesion is more with the irritant red rubber tubes like Malecot's catheter than with the inert PVC tubes. When removing the drain, one should cut the stitch anchoring the drain to the skin following which the tube should be twisted 360⁰ thereby breaking the flimsy fibrinous adhesions between abdominal structures and the tube. It is only after twisting and when one finds a sudden give should the tube be pulled out.

REFERENCE

1. De U. Evisceration of appendix through abdominal drainage site. Indian J Surg. 2002; 64: 459-60.

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