A case of short bowel syndrome with pulmonary embolism during long-term home parenteral nutrition using central venous port systems

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  • Kawai Masahiko
    Gifu Prefectural General Medical Center, Nutrition Support Team Gifu Prefectural General Medical Center, Depar tment of Surgery
  • Iida Mami
    Gifu Prefectural General Medical Center, Nutrition Support Team Gifu Prefectural General Medical Center, Depar tment of Internal Medicine
  • Yoshida Tomoko
    Gifu Prefectural General Medical Center, Nutrition Support Team Gifu Prefectural General Medical Center, Nutrition Department
  • Kodera Satoshi
    Gifu Prefectural General Medical Center, Nutrition Support Team Gifu Prefectural General Medical Center, Pharmaceutical Department
  • Tanaka Satomi
    Gifu Prefectural General Medical Center, Nutrition Support Team Gifu Prefectural General Medical Center, Department of Nursing

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  • CVポートを用いた長期HPN施行中に肺塞栓症を合併した短腸症候群の1例

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Pulmonary embolism caused by long-term catheterization of the central venous port system is rare. A woman in her 60s underwent subtotal colectomy for familial adenomatous polyposis with transverse colon cancer in 2003. She underwent surgery due to desmoid tumor in the mesentery of the jejunum and received a jejunal stoma because of anastomotic insufficiency, which had developed into short bowel syndrome in 2005. In September 2006 she was treated as an inpatient for septic DIC syndrome caused by infection of the central venous port. For four months in 2007 she was treated as an inpatient for pyogenic spondylitis of the lumbar spine due to MRSA infection. In 2008 she received inpatient treatment for fungal infection of the central venous port and in 2011 she was treated as an inpatient for a similar septic DIC syndrome. We attempted re-catheterization of the central venous port system, but catheterization to SVC failed. Therefore, we catheterized the tip to the pericardiacophrenic vein. Multiple polyps were detected on the residual rectum and reoperation was under consideration, however thrombosis developed in the right pulmonary artery, as shown by contrast-enhanced CT in September 2011. She had normal cardiac function with no pulmonary hypertension and no history of deep venous thrombosis. The central venous port was suspected to be the cause of thrombus formation. Therefore, warfarin treatment was attempted, but it had no effect. Resection of the residual rectum was performed in January 2012. Home parenteral nutrition has been continued with oral warfarin. It is critical to monitor for venous thromboembolism & pulmonary embolism during long-term home parenteral nutrition.

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