Colonic stenosis caused by infection of an intraperitoneal access port system: a rare complication of intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis

Abstract

Background: Intraperitoneal (i.p.) chemotherapy is garnering attention as an effective treatment for gastric cancer with peritoneal metastasis. We report the case of a patient who developed colonic stenosis caused by infection of an i.p. access port system during i.p. chemotherapy. It was difficult to differentiate whether the extrinsic colonic stenosis arose from a catheter infection or peritoneal metastasis of the gastric cancer.

Case presentation: A 66-year-old Japanese man underwent total gastrectomy for gastric cancer. Because the intraoperative findings revealed peritoneal metastasis, a port system was implanted for subsequent i.p. chemotherapy. Two months after initiation of chemotherapy, he complained of vomiting and abdominal pain. A computed tomography scan revealed marked thickening of the sigmoid colon wall adjacent to the catheter of the i.p. access port system. A barium enema demonstrated extrinsic irregular stenosis of the sigmoid colon. Although it was difficult to distinguish whether infection or peritoneal metastasis had caused the colonic stenosis, we removed the port system to obtain a therapeutic diagnosis. Coagulase-negative staphylococci were detected by catheter culture. The wall thickening and stenosis of the sigmoid colon completely resolved after removal of the port system.

Conclusions: We report the case of a rare complication in association with an i.p. access port system. Infection of the port system should be considered as a differential diagnosis when colonic stenosis adjacent to the catheter is observed during i.p. chemotherapy.

Figure 1

Intraperitoneal access port system. The intraperitoneal access port system comprised of a titanium port with a bottom diameter of 31.47 mm, a height of 14.5 mm, and a 14.3-Fr single-lumen silicone catheter.

Figure 2

Computed tomographic changes in sigmoid colon before and after removal of intraperitoneal access port system. (A) A computed tomography scan showed marked wall thickening of the sigmoid colon (closed triangle) adjacent to the catheter (arrowhead) before removal. (B) Seven days after port removal, the wall thickening of the sigmoid colon had improved (open triangle).

Figure 3

Extrinsic irregular stenosis of the sigmoid colon on barium enema. (A) Barium enema showed extrinsic irregular stenosis of the sigmoid colon around the catheter (arrowheads). (B) Four months after removal of the port system, the stenosis of the sigmoid colon had completely disappeared.