Drain site abdominal hernia: a known but rare complication of abdominal drains – a case report

Introduction: Abdominal drains are commonly used in surgical practice to prevent fluid collection and facilitate postoperative recovery. Drain site hernia is a rare but potentially serious complication that may present late and lead to intestinal obstruction. Case presentation: A 44-year-old woman presented with abdominal pain, distension and vomiting for three days. She had undergone exploratory laparotomy for an appendicular abscess four years earlier, during which an abdominal drain had been placed in the right iliac fossa. Two years after surgery, she noticed a swelling at the previous drain site, which remained asymptomatic until the present admission. On exploration, small bowel loops and omentum were found herniating through the previous drain site. The bowel was viable and was reduced. An irreducible oedematous portion of omentum was excised, and the defect measuring more than 20 mm was closed in layers using non-absorbable sutures. The postoperative course was uneventful. Discussion: Drain site hernia is reported more frequently after laparoscopic procedures but can also occur following open abdominal surgery. Drain size, insertion technique and inadequate closure of the drain tract are important predisposing factors. Conclusion: Drain site hernia should be considered in patients presenting with swelling or features of intestinal obstruction at previous drain sites, even several years after surgery. Appropriate drain selection, meticulous insertion technique and careful removal are essential to prevent this complication.