Endoscopic Removal of an Entrapped Abdominal Drain, With the Operative Devices Introduced Through the Lumen of the Drain, Following Cytoreductive Surgery for Pseudomyxoma Peritonei: A Case Report

Background: Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy that is typically managed with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). However, prolonged abdominal drainage in these patients may lead to catheter entrapment due to encapsulation by fibrous tissue. Case: A 48-year-old patient with PMP underwent CRS with placement of an abdominal drain. On postoperative day 10, the drain was found to be entrapped, and multiple removal attempts failed due to significant resistance and patient discomfort. To avoid reoperation, a 5 mm hysteroscope served as an endoscopic platform. It was introduced through the drainage lumen, which allowed precise dissection of the encapsulating fibrous tissue under direct visualization and subsequent successful tube removal. Histopathologic examination confirmed the presence of fibrotic tissue with inflammatory infiltration. Conclusions: To our knowledge, this report is the first to describe the endoscopic management of an entrapped abdominal drain via the drain lumen, establishing this approach as a viable and minimally invasive alternative to reoperation. This case further highlights the need to reconsider drain design in patients with PMP, who show a predisposition to this complication due to intense fibrogenesis.