Management of a iatrogenic cecal perforation after abdominal drain
placement on a horse
Summary: A 16-year-old, French Saddlebred was referred for 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 recovered
uneventfully, but the next day developed moderate signs of endotoxemia
and severe sero-sanguineous discharge from the abdominal wound.
Substantial peritoneal effusion was assessed on abdominal ultrasound and
required an abdominal drain placement. The site was at first checked
with ultrasound, and insertion of a redon drain was performed.
Immediately, a brown smelly liquid drained in large quantities (figure
1), and examination of this liquid revealed it to be enteral fluid. The
drain was pushed in the viscera and the horse brought to surgery.
Placement of an embolectomy catheter was performed before induction and
as the horse was induced the balloon catheter was inflated. The drain
was pulled out of the viscera and traction on the embolectomy catheter
was kept until a repeat laparotomy was performed (figure s2). Moderate
contamination of the abdominal cavity occurred during the iatrogenic
perforation of the cecum. The balloon catheter effectively occluded the
breach in the cecum and revealed to be strong enough to pull on the
viscera without tearing it. The abdominal cavity was then lavaged with
80 L of ringer lactates and another abdominal drain was placed. The
horse recovered uneventfully and did not display any further
complication during the rest of his hospitalization. The horse returned
within 6 months to its intended use. KEY POINTS Abdominal drain
placement carries risks of complication, one of them being enteric
placement of the drain Temporary occlusion of the defect is feasible
using an embolectomy catheter pending surgery If swift action is taken,
contamination of the abdominal cavity can stay moderate.