Baclofen pump catheter leakage after migration of the abdominal catheter in a pediatric patient with spasticity

Abstract

<jats:p>The authors report an unusual case of intrathecal baclofen withdrawal due to the perforation and subsequent leakage of a baclofen pump catheter in a patient with spastic cerebral palsy. A 15-year-old boy underwent an uncomplicated placement of an intrathecal baclofen pump for the treatment of spasticity due to cerebral palsy. After excellent control of symptoms for 3 years, the patient presented to the emergency department with increasing tremors following a refill of his baclofen pump. Initial evaluation consisted of radiographs of the pump and catheter, which appeared normal, and a successful aspiration of CSF from the pump’s side port. A CT dye study revealed a portion of the catheter directly overlying the refill port and extravasation of radiopaque dye into the subfascial pocket anterior to the pump. During subsequent revision surgery, a small puncture hole in the catheter was seen to be leaking the drug. The likely cause of the puncture was an inadvertent perforation of the catheter by a needle during the refilling of the pump. This case report highlights a unique complication in a patient with an intrathecal baclofen pump. Physicians caring for these patients should be aware of this rare yet potential complication in patients presenting with baclofen withdrawal symptoms.</jats:p>

Adverse events associated with paediatric intrathecal baclofen in Australia: 5 years of data collection

“…An infection rate of 10% is consistent with that reported internationally 16 . All infection‐related complications occurred within 2 months of surgery.…”

“…This is likely due to prospective collection of all AEs, including mild, moderate and severe events, while most other studies have used retrospective data and report only events requiring surgical intervention 5,6 . The rate of surgical intervention required as the result of an AE (25%) for our population is consistent with AE rates described in international literature 5,6,16 …”

Plain radiography in patients treated with intrathecal drug delivery using an implantable pump device

“…In case the catheter surplus is located above the pump reservoir, refilling with medication or injecting contrast material in the catheter access port might result in catheter puncturing. Catheter perforation can result in dose adjustment problems, or even in a severe withdrawal syndrome [ 38 ]. Control identifier …”

The use ultrasound guided for refilling intrathecal baclofene pump in complicated clinical cases: A practical approach

“…For instance the migration of the pump into the peritoneal cavity or baclofen pump pocket infection have been previously described. Children appear to be at higher risk for complications than adults [16][17][18].…”