2025 Volume 61 Issue 4 Pages 750-754
The patient was a 14-year-old male. At 2 weeks of age, he went into shock after the first formula feeding and was rushed to the hospital. A laparotomy performed after resuscitation revealed massive necrosis of the small intestine, resulting in short bowel syndrome with 38 cm of the small intestine remaining, and a histopathological examination revealed small-intestine-type Hirschsprung’s disease. At 4 months of age, a right colon patch was performed by the Kimura method; however, he could not be weaned from parenteral nutrition via a central venous catheter (CVC). Owing to the malabsorption of nutrients by the short intestine, home parenteral nutrition was continued, and the CVC was replaced 11 times in 9 years because of infection and other reasons, and it became difficult to manage skin problems on the chest wall where a subcutaneous tunnel was created. A subcutaneous tunnel was placed in the upper arm based on the indwelling CV port in the upper arm. The technique was similar to PICC and CV port placement, and the subcutaneous tunnel could be placed without any trouble. It has been well received by families as it allows the skin on the chest wall to rest and allows easy management of the upper arm. In cases where it is difficult to create a subcutaneous tunnel in the chest wall, an indwelling Broviac® catheter in the upper arm was considered an option for older children or patients with severe mental and physical disabilities.
