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.