Iatrogenic cecal perforation after abdominal drain placement on a horse.

Abstract

A 16-year-old, French saddlebred horse was referred for examination because of colic signs, diagnosed with incarceration of the jejunum in a mesoduodenic rent, and subsequently treated surgically (with an end-to-end anastomosis of the jejunum and an enterotomy of the pelvic flexure). The horse initially recovered without complications; however, on the following day, it exhibited moderate signs of endotoxemia and severe serosanguineous discharge from the abdominal wound. Abdominal ultrasonography revealed substantial peritoneal effusion, necessitating the placement of an abdominal drain. The blind drain insertion resulted in the drainage of a brown, malodorous liquid, identified as enteral fluid. Subsequently, the drain inadvertently penetrated the viscera, prompting immediate surgery. An embolectomy catheter was placed in the drain before induction, and the Fogarty catheter cuff was inflated as the horse was induced. The drain was carefully removed from the viscera, maintaining traction on the embolectomy catheter until a repeat laparotomy was done. Moderate contamination of the abdominal cavity occurred during the iatrogenic perforation of the cecum. The balloon catheter effectively sealed the breach in the cecum, demonstrating sufficient strength to pull on the viscera without causing tears. The abdominal cavity was lavaged with 80 L of Ringer's lactate, and another abdominal drain was placed. The horse recovered without further complications throughout the remainder of its hospitalization and returned to its intended use within 6 mo. Key clinical message: Abdominal drain placement carries the risk of complications, including enteric misplacement. Temporary occlusion of the defect is achievable using an embolectomy catheter pending surgery. Swift action in response to complications can help limit contamination of the abdominal cavity.