Neonatal Med.  2018 Nov;25(4):196-201. 10.5385/nm.2018.25.4.196.

Umbilical Venous Catheter Complication Presenting as Chylous Ascites in a Newborn: Intraperitoneal Extravasation of Total Parenteral Nutrition Infusate

• Lee HM
• Sung HJ
• Lee HS

• KMID: 2436139
• DOI: http://doi.org/10.5385/nm.2018.25.4.196

Abstract

Umbilical venous catheterization (UVC) is a common practice in intensive neonatal care. However, a malpositioned UVC and its prolonged use may lead to various problems, including mechanical, infectious, and thrombotic complications in various organs such as the liver, lungs, and heart. Congenital chylous ascites is characterized by abnormally high levels of triglycerides in the peritoneal fluid of newborns, which originate from refluxed lymph within the abdominal cavity. Herein, we report a case of an UVC complication presenting as chyloperitoneum simulating congenital chylous ascites in a preterm neonate that resulted from total parenteral nutrition (TPN) extravasation from a malpositioned UVC. Biochemical analysis of intraperitoneal chylous fluid and TPN infusate could help confirm the origin of chyloperitoneum. This case suggests that TPN extravasation from UVC should be considered when chyloperitoneum develops in newborns with an indwelling catheter. UVC positions must also be carefully monitored at regular intervals to recognize associated complications early, particularly in cases with an inevitably malpositioned catheter related to the anatomy of the vessel course.

Keyword

Umbilical venous catheter; Chylous ascites; Total parenteral nutrition; Newborn

MeSH Terms

Abdominal Cavity
Ascitic Fluid
Catheterization
Catheters*
Catheters, Indwelling
Chylous Ascites*
Heart
Humans
Infant, Newborn*
Liver
Lung
Parenteral Nutrition, Total*
Triglycerides
Triglycerides

Figure

• 

  Figure 1. Abdominal radiography image obtained immediately after umbilical venous catheter insertion, showing the catheter tip within the liver shadow below the right diaphragm, indicating that the tip was likely located inside the right hepatic vein.

• 

  Figure 2. Anteroposterior radiography image of the abdomen depicting abdominal distension. The catheter tip (white arrow) was likely located at the portion of the umbilical vein, which was traversing superficially parallel to the cutaneous surface on lateral view.

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  Figure 3. Computed tomography scan of the abdomen demonstrating a large amount of ascites.

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  Figure 4. Abdominal paracentesis yielding 31 mL of milky-white chylous intraperitoneal fluid, which was extravasated with a total parenteral nutrition solution.

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