LETTERS TO THE EDITOR
|Year : 2023 | Volume
| Issue : 5 | Page : 446-448
Disc dislocation of chemoport: An unseen complication
A Sushma, Rahul Deo Sharma, Surendra Singh, Sonia Thakur, Rajeev Redkar
Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
|Date of Submission||28-Feb-2023|
|Date of Decision||03-Jun-2023|
|Date of Acceptance||05-Jun-2023|
|Date of Web Publication||05-Sep-2023|
Department of Paediatric Surgery, Lilavati Hospital and Research Centre, Bandra West, Mumbai - 400 050, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sushma A, Sharma RD, Singh S, Thakur S, Redkar R. Disc dislocation of chemoport: An unseen complication. J Indian Assoc Pediatr Surg 2023;28:446-8
|How to cite this URL:|
Sushma A, Sharma RD, Singh S, Thakur S, Redkar R. Disc dislocation of chemoport: An unseen complication. J Indian Assoc Pediatr Surg [serial online] 2023 [cited 2023 Oct 2];28:446-8. Available from: https://www.jiaps.com/text.asp?2023/28/5/446/385146
| Introduction|| |
Childhood cancers have become curable with the availability of aggressive chemotherapy regimens and improved supportive care. Totally, implantable venous devices (TIVDs) facilitate effective long-term chemotherapy. However, TIVDs can have some complications. Diagnosing these cases is easy as the complication is usually clinically evident. The management is based on presenting symptoms as well as type of complication. We present here an unusual case of a rare and unseen complication, could not be suspected, or confirmed by local ultrasonography, requiring surgical removal under general anesthesia.
| Case Report|| |
A 2-year-old boy, who was a diagnosed case of acute myeloblastic leukemia, was planned for chemotherapy. He was admitted for central intravascular access of a definitive device, i.e., chemoport insertion for long-term chemotherapy. A preconnected chemoport catheter (Bard, 6.6 Fr) was placed in the right internal jugular vein in November 2018, and position was confirmed by intraoperative fluoroscopy. The child was receiving the induction phase, daily chemotherapy through this port, high-dose cytarabine, had shown good backflow, and was functioning effectively with no difficulty in chemoinfusion. After 22 days of port insertion, swelling was seen over the chemoport region with no backflow. Ultrasound chest showed chemoport in subcutaneous plane without any collection. Open removal of chemoport was planned under general anesthesia. Port chamber was brought out. Diaphragm (silicon disc) was displaced [Figure 1] and clots were present around the port chamber and the procedure was uneventful. Swab culture from the port site showed no growth. The patient had uneventful recovery and was discharged after 2 days. Further, chemotherapy was uneventful by a peripherally inserted central catheter in the left arm in the next admission.
|Figure 1: Preconnected chemoport with displaced silicon disc (diaphragm) within the port chamber|
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| Discussion|| |
TIVDs have been used increasingly in cancer patients since the mid-1980s. TIVDs facilitate effective long-term chemotherapy as well as parenteral nutrition, fluid replacement, and frequent blood sampling. However, TIVDs are not without complications. They can be grouped into immediate, early, and late complications. Mechanical complications such as patency impairment, and catheter fracture, catheter line displacement, twisted port, catheter fracture with leakage or migration, and air embolism are the notable late complications. We have reviewed literature regarding mechanical complications as we consider our complication as mechanical type.
Aitken and Minton first described “pinch-off sign,” as the catheter inside the subclavian vein gets compressed between the clavicle and the first rib is the usual site of catheter fracture.
Shah et al. reported that the incidence of rate of complications is about 13% in their study, of which catheter fracture and cardiac migration are potentially dangerous complications with estimated frequency of 0.1%. Srivatsa et al. demonstrated the incidence of catheter fracture is 2.3%. Nakamura et al. reported the incidence of catheter fracture and embolization to be ranged from 1.1% to 2.1%. Redkar et al. reported an overall complication rate of 11/72 cases (15.27%) with catheter tip occlusion in one patient.
The disc is a silastic one, self-sealing with maximum port punctures of 2000 can be made. In our case, we found swelling at the chemoport site while activating the port. Disc dislocation is the rare and unexpected cause in our case. The possible cause of disc dislocation could be manufacturing defect or caused by misdirecting the Huber needle while activating port. Either way, chemoport needs to be removed under direct vision in case of catheter fracture or suspected disc dislocation. Other causes of swelling at the chemoport site include extravasation of chemo drugs, thrombosis, and fracture. Ultrasound of the local part is advisable to differentiate all the above causes.
| Conclusion|| |
We report this case to increase the awareness within community as well as among medical practitioners about this rare complication of chemoport. We have not found any article in the literature about dislocation of disc from chemoport chamber. One must suspect this kind of complication if swelling is seen over the chemoport site. This is a unique case because spontaneous dislocation of silastic disc of intravascular access devices is very rare.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chang CL, Chen HH, Lin SE. Catheter fracture and cardiac migration – An unusual fracture site of totally implantable venous devices: Report of two cases. Chang Gung Med J 2005;28:425-30.
Aitken DR, Minton JP. The “pinch-off sign”: A warning of impending problems with permanent subclavian catheters. Am J Surg 1984;148:633-6.
Shah M, Patni S, Bagarahatta R. Spontaneous chemoport fracture and cardiac migration. Indian J Surg Oncol 2014;5:325-6.
Aparna S, Ramesh S, Appaji L, Srivatsa K, Shankar G, Jadhav V, et al
. Complications of chemoport in children with cancer: Experience of 54,100 catheter days from a tertiary cancer center of Southern India. South Asian J Cancer 2015;4:143-5.
] [Full text]
Nakamura T, Sasaki J, Asari Y, Sato T, Torii S, Watanabe M. Complications after implantation of subcutaneous central venous ports (PowerPort(Ⓡ)). Ann Med Surg (Lond) 2017;17:1-6.
Redkar R, Bangar A, Krishnan J, Raj V, Swathi C, Joshi S. Role of chemoports in children with hematological/solid tumor malignancies – Technical implications and complications: An institutional experience. J Indian Assoc Pediatr Surg 2019;24:27-30.
] [Full text]