Case Report: Postoperative ascites: allergic reaction to the drainage tube in a 12-year-old patient

Abstract

Allergic reaction to the silicone is rare in children and as a result very little experience has been reported on symptom and treatment. We presented a case involving a child who experienced prolonged ascites following a surgery of placing an abdominal drainage tube, characterized by the ongoing drainage of clear, light-yellow fluid at a rate of 250 mL/day through the drainage tube for 36 days. Examination of the ascitic fluid revealed an abnormal elevation in eosinophil proportion, which exhibited positive response to anti-allergic treatment. Subsequent to the removal of the drainage tube, the ascites gradually resolved. In conclusion, we presented here the first and youngest case of allergic ascites associated with drainage tube after surgery of ovarian mucinous cystadenoma, it is imperative not to overlook the possibility of drainage tube allergy in the diagnostic process.

Keywords: allergy and immunology; ascites; case report; mucinous cystadenoma; silicone; suction drainage.

Figure 1

Preoperative CT scan contrast with postoperative MRI scan of abdomen. (A–C) Presents plain and enhanced CT scan of preoperative abdomen: There was a colossal divided cystic mass with clear boundaries about 23 cm × 15 cm × 32 cm (left and right × front and rear × up and down) in the abdominal and pelvic cavities. (D–F) Presents plain and enhanced MR scan of postoperative abdomen: There was multiple free fluid signal shadows in the abdominal and pelvic cavities; Local continuity interruption on the right abdominal wall, with a drainage tube visible inside. The size and morphology of the right ovary was in the normal range contrast with left ovary. No lymph node enlargement was observed in the abdominal cavity or retroperitoneum. No abnormal signals were observed in various organs, bones, and surrounding soft tissues.

Figure 2

The surgical findings and pathology of neoplasm. (A) The subcapsular cyst about 30 cm × 28 cm × 15 cm originates from the right ovary. (B) The ovarian cortex was sutured to a size of approximately 4 cm × 3 cm × 2 cm without active bleeding. (C) Pathology of neoplasm: The tumor presents as a multicystic structure, lined with a single layer of columnar epithelium, with focal papillary hyperplasia. The epithelium shows pseudostratified hyperplasia, while the small lesion epithelium shows mild atypical hyperplasia. (D) The light-yellow clear ascites. (E) The silicone drainage tube.

Figure 3

Variation of ascites and body weight. Time represents days post-surgery. The column graph represents the volume of ascites, and the line graph represents the changes in body weight. The column graph in pink color represents the ascites during anti-allergy treatment. Ascites significantly decreased with anti-allergic treatment, and after discontinuing anti-allergic treatment, ascites significantly increased after 4 days.