Feeding jejunostomy (FJ) is a commonly done surgical procedure for enteral nutrition. Intussusception is one of the rare complications of FJ. Clinical presentation may be similar to other causes of small bowel obstruction. Intussusception should be suspected if a patient with jejunostomy tube develops upper gastrointestinal obstructive symptoms, which are relieved by nasogastric tube drainage. CT or ultrasonography (USG) can help to confirm the diagnosis. It can be relieved spontaneously or sometimes requires laparotomy. We have encountered such complication in one patient. The patient developed intestinal obstruction after removal of FJ tube and was diagnosed as having intussusception radiologically. On exploration, intussusception was identified at FJ site for which surgical reduction was done.
Central venous access devices are routinely used in oncology for delivering chemotherapy of which implantable chemoports are the most common. Spontaneous breakage and migration of the catheters is a very rare but known complication of the procedure. Patients will usually present with cardiac manifestations in form of chest pain or arrythmias. Herein we report a case of spontaneous breakage and cardiac migration in which the patient was asymptomatic. Patient was successfully managed by an interventional cardiologist.Keywords Chemoport . Fracture . Migration A 3 year old male child was diagnosed as having Hodgkins lymphoma and subsequently planned for chemotherapy in our hospital. A chemoport catheter (bard, 6.6f) was placed in the right internal jugular vein and port was placed in the chest wall for chemotherapy. After the procedure, a chest x ray revealed good placement of the chemoport. Then the child underwent 6 cycles of chemotherapy in next 6 months through this port and had a very good response. Patient was then planned for port removal. On examination it was found that the port was in situ but the catheter was not palpable in the subcutaneous tissue of the neck. A chest radiograph was performed due to suspicion of catheter migration secondary to spontaneous breakage (dislodgement) of chemoport catheter. It showed that the chemoport catheter had migrated from its original location up to the right ventricle, travelling across the right atrium and right ventricle through pulmonary artery. (Fig. 1). Surprisingly the child was asymptomatic and there were no ECG changes as well. Patient was then referred to a cardiology department for a possible percutaneous retrieval of the migrated catheter. As the patient was asymptomatic and stable so an elective procedure was planned. On the next day patient was taken to cath lab and retrieval was done under fluoroscopic guidance under general anesthesia. The right femoral vein was punctured, and a 6Fr sheath was inserted. Percutaneous retrieval of migrated catheter was performed with a 6 Fr snare (peripheral snare, Cordis) (Fig. 2). Floating end of the migrated catheter in right atrium was snared and pulled down via inferior vena cava towards right femoral vein under fluoroscopic guidance and finally the port catheter fragment along with retrieval set were removed through right femoral vein (Fig. 1). The length of the migrated piece was 8cm, and no thrombus was observed at the tip (Fig. 1). No major complication occurred during and after the procedure and the patient was discharged on the next day. This is a unique case because spontaneous breakage of venous access devices is very rare and patients are usually symptomatic.
DiscussionTotally implantable venous devices 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. Early complications include incorrect position, improper a...
GM-CSF reduces the severity of acute side effects of radiation therapy thereby allowing completion of the treatment without interruption. Its remarkable response needs to be evaluated further in large randomized trials. The time of initiation and cessation of GM-CSF during radiation therapy and the required dose needs to be established.
Neuroendocrine tumors (NET) are the neoplasm arising from neuroendocrine cells which are present throughout the body. It can be benign, being more common or malignant. Gut is the most common site, but they can be seen in any part of the body. We had a case of grade III NET in axilla presented with a fungating lesion with unknown primary. Clinical behavior of such tumor is predicted by tumor grade or differentiation. We treated this patient by surgery and adjuvant chemotherapy.
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