“Maypole” small bowel obstruction from Jackson Pratt drain

Darshak Shah, MD, MBBS, Howard Tiszenkel, MD, Ashish Padnani, MD, MBBS, Saurabh Sharma, MD, MBBS. New York Hospital Queens, New York.

Closed system continuous suction drainage was introduced by Barron and Raffle in Great Britain in 1950s. Silicone rubber drains first became available in 1960s and its advantages were reported by Santos et.al. in 1962 in the first modern experiment on surgical drainage. Jackson Pratt (JP) drains are made of silicone. There are several publications on evidence based review of regular use of surgical drains.

We report a case of 78 year old male patient who underwent low anterior resection with loop ileostomy and JP drain placement for rectal cancer, complicated by small bowel obstruction and necrosis. JP drain acted as a "maypole" around which small bowel was twisted causing obstruction and necrosis. Patient underwent an exploratory laparotomy, small bowel resection with primary anastomosis. Patient required a prolonged Surgical ICU stay, ventilator support and feeding tube placement.

Surgical drains should be used very judiciously and it should not be made a routine to place JP drains. Surgeon should keep in mind potential complications of drain placement and decide if the benefits outweigh the risks of placement.

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