A Case of an Infant With Short Bowel Syndrome who Underwent Central Venous Port Placement Through Right Intercostal Venipuncture With Thoracoscopic Assistance

Abstract

Alternative methods of central venous catheter placement are considered in patients with occlusion of main access routes for central venous catheter insertion. We report the case of an infant with short bowel syndrome (focusing particularly on the surgical technique), who underwent successful placement of a central venous port through the azygos vein via the fifth intercostal vein under ultrasound guidance with thoracoscopic assistance. A 4-year-old boy with short bowel syndrome who received home parenteral nutrition developed recurrent catheter-induced bloodstream infections, which obstructed the superior vena cava and bilateral femoral veins. A dilated azygos vein was identified as a collateral bypass; therefore, we performed a right sixth intercostal vein puncture under ultrasound guidance and placed a central venous catheter via the azygos vein. The distal aspect of the confluence of the azygos vein was blocked during thoracoscopic surgery to introduce the guidewire into the superior vena cava, and a catheter was inserted into the azygos arch. Displacement of the catheter from the intercostal vein necessitated catheter reinsertion via the right fifth intercostal vein, one month postoperatively. The patient has had an uneventful course over 10 months postoperatively, and home total parenteral nutrition has been continued. Ultrasound-guided puncture of an intercostal vein under thoracoscopic guidance may be useful for central venous catheter placement in infants.