Mind the Drain: Inadvertent Colonic Puncture after Mediastinal Drain Insertion in a High-risk Cardiac Surgical Patient

Cardiothoracic surgeries are known to cause gastrointestinal complications due to its proximity to the peritoneal cavity. Such complications in susceptible patients are associated with adverse post-operative outcomes. While the majority of cases reported in the literature were related to intrinsic GI complications as consequences of physiological disturbance, e.g. stress ulcers and mesenteric ischaemia, complications originating from extrinsic factors, e.g. instrumentation and drain insertion, are infrequently discussed and the potential risks can be equally great if not higher. Relevant to this, we present a case of colonic perforation secondary to a misplaced mediastinal drain in a patient who underwent a high risk redo surgery for mitral valve replacement.