Missed drain in the abdomen discovered during cesarean section at 28 weeks of gestation

A 28 years old lady, medical free, primary infertility 5 years, underwent IVF, then she became pregnant, triplet pregnancy.

Her pregnancy was complicated by ovarian hyperstimulation syndrome, admitted to the hospital, conservative mangment done, on us : sever ascitis diagnosed, cystocath drain was inserted, patient managed as inpatient for 5 days, then she discharged home, with drain in situ, followed up for several days after disharge, the drain finally didn’t drain any fluid it was removed by obestetricion outside hospital. After that her pregnancy run without complications apart from recurrent attacks of generalized abdominal pain. On antenatal visits, her complaint was described as normal pregnancy symptoms.

Her abdominal pain became worse with pregnancy advance. Nothing specific diagnosed, at 28 weeks of gestation, she presented to us complaining of abdominal pain, generalized, with vomiting. Admitted for further investigations and mangment, 3 hours after admission, she devolped pre term rupture of memberans. On us triple pregnancy, fatal heart present for all, all breech presentation. Sterile vaginal exam, confirmed the diagnosis of pre term pre mature rupture of memberans. Soon later her abdominal pain worsed with active gush of fluid per vagina. Vaginal exam repeated and showed dilated effaced cervix. Urgent cesarean sectionwas done. During cesarean section, massive omentalabd bowel adhesions diagnosed.After delivery of all three fetuses alive and closure of the uterus., the adhesions reviewed .

Long tubular structure noticed protruding from the adhesions, surgeon called, the tubular structure has many holes, at same time, proximal bowel founded to be dilated. Adhesoilysis done, the tube removed, looks like a drain, washing done, several bands of adhesions removed, dilated bowel return normal, deppiser drain inserted, count correct , hemostsis secured, closure ofrectus sheath ,subcutaneous fat and skin. Patient stayed for three day’s, covered by antibiotic no complications happened, deppiser drain removed. Patient discharged home in good condition., drain was taken by patient. Follow up done at our hospital for three weeks, no any complications happened also.