Complications of Tenckhoff catheter implantation in patients with multiple previous intraabdominal procedures for ovarian carcinoma

Iatrogenic placement of a Tenckhoff catheter in the bladder of a diabetic patient after penectomy

The placement of permanent peritoneal catheters for dialysis of patients with renal failure is safe and has been popular since its modification by Tenckhoff. The majority of complications associated with these catheters are infectious in nature, manifesting as peritonitis or insertion site skin infections. Occasionally, serious complications may occur. We report the iatrogenic placement of a Tenckhoff catheter in the bladder of a penectomized patient. Consideration to this surgically altered lower genitourinary tract may have avoided this rare complication as well as aided in the postoperative management of this patient.

Intraperitoneal catheters: percutaneous placement with fluoroscopic guidance

PURPOSE

The authors reviewed their experience with percutaneous placement of catheters into the peritoneal cavity for the administration of intraperitoneal chemotherapy to determine if their approach resulted in a lower complication rate than the reported 12%-16% rate and to demonstrate the technical advantages over surgically placed catheters.

PATIENTS AND METHODS

Seventy-six patients with gastrointestinal or gynecologic malignancies underwent 152 procedures during a 20-month period. The catheters were used to deliver antineoplastic agents and, in some patients, to drain ascites. Catheter insertion was performed with local anesthesia and a modified Seldinger technique. A 5-F catheter was used in 89% of procedures; in the remainder, the catheter was of a larger caliber.

RESULTS

The procedure was successful in 145 (95%) instances and failed in seven (5%) attempts because of peritoneal adhesions. The catheters remained in place for less than 2 days in 56%, 2-10 days in 25%, and more than 10 days in 19% of patients. One catheter remained in place for 15 weeks. Complications occurred in seven procedures (5%). Four cases of mild peritonitis responded to a brief course of intravenously administered antibiotics, and severe pain in two patients required premature catheter removal. A single case of inadvertent transcolonic catheter placement occurred without adverse sequelae to the patient.

CONCLUSIONS

Intraperitoneal catheterization can be performed with local anesthesia by using a simple technique with a very low complication rate. The catheters can remain in place for prolonged periods without significant risks.