Retained drains causing a bronchoperitoneal fistula: a case report
1 Johns Hopkins Hospital Department of Surgery, Baltimore MD, USA
2 Johns Hopkins Hospital, Department of Anesthesiology and Critical Care Medicine, Division of Adult Critical Care Medicine, Baltimore, MD, USA
3 Johns Hopkins Hospital, Department of Surgery, Baltimore, MD, USA
4 Washington University School of Medicine, Department of Acute and Critical Care Surgery, Barnes Jewish Hospital, St Louis, MO, USA
Journal of Medical Case Reports 2011, 5:185 doi:10.1186/1752-1947-5-185Published: 14 May 2011
Bronchoperitoneal fistulas are extremely rare. We present a case where retained surgical drains from a previous surgery resulted in erosion and fistula formation. This condition required an extensive surgical procedure and advanced ventilator techniques.
A 24-year-old African-American man presented to our Emergency Department with a one-week history of fever, dyspnea, cough, and abdominal pain. A computed tomography scan of his chest and abdomen revealed bilateral lower lobe pneumonia and two retained Jackson-Pratt drains in the right upper quadrant. He was taken to the operating room for drain removal, a right hemicolectomy, debridement of a duodenal injury, a Roux-en-y duodenojejunostomy, and an end ileostomy. He subsequently became increasing hypoxemic in the intensive care unit and a bronchoperitoneal fistula was diagnosed. He required high-frequency oscillatory ventilation followed by lung isolation, and was successfully resuscitated using these techniques.
To the best of our knowledge, this is the first known case report of a bronchoperitoneal fistula caused by retained surgical drains. This is also the first known report that details successful management of this condition with advanced ventilatory techniques. This case highlights the importance of follow-up for trauma patients since retained surgical drains have the potential to cause life-threatening complications. When faced with this condition, clinicians should be aware of advanced ventilatory methods that can be employed in the intensive care unit. In this case, these techniques proved to be life-saving.