IndianJ. Ptdlatr. 44 :
22, 1977
P E R I V E S I C A L ABSCESS: A N U N U S U A L C O M P L I C A T I O N OF F E M O R A L VENEPUNCTURE* Report of a Case
S.K.S. MARYA, SttAVINDER KUMAR AND NEERAJ GAUR Rohtak
Femoral venepunclure is widely practised for raking blood samples for investigations and parenteral administration of drugs and fluids in collapsed patients, especially infants and children. Various complications like local sepsis, h a e m a t o m a formation, arterial damage, vascular thrombosis (Goldbloom a al. 1967) and gangrene of the limb (Polesky and Harvey 1968) have been recorded, following repeated puncture of the femoral vein. T h e following report of a case illus1rates a potentially severe and probably unreported complication of femoral venepuncture. Report of a Case
R.K., a 5-month-old child, was admitted to the paediatrics ward with dehydration due to diarrhoea of two days' duration for which the femoral veins were repeatedly punctured for taking blood samples and for administration of fluids. During his stay in the hospital, the patient developed a high grade fever and a mass in the hypogastrium for which he was referred to the surgical department. Rectal examination revealed a boggy swelling on the left side. Intravenous pyelography and cyslography showed that the urinary bladder was pushed to the right side. Keeping in mind the provisio*From the Department of Surgery, Medical College, Rohtak. Received on August 31, 1976.
nal diagnosis of pelvic abscess, an exploratory laparotomy was carried out. There was no intraperitoneal pathology. A needle aspiration of the mass, after closing the peritoneum, revealed frank pus which was drained extraperitoneally. Discussion
This report illustrates the occurrence of a perivesical abscess as one of the rare but dangerous complications of repeated femoral vein puncture. Many other complications of femoral venepuncture, such as arterial thrombosis (Goldbloom et al. 1967, M c K a y 1967), gangrene of the extremity (Polesky 1968), vascular thrombosis and embolism (Matalon 1970) and septic arthritis of the hip (Ashes 1966), have been reported. However, in the available English literature, we have not come across perivesical abscess being reported as a complication of femoral venepuncture. T h e condition reported herein may be confused with various other pathological conditions, e.g. pelvic abscess, infected diverticulum of the urinary bladder, saero-eoccygeal teratoma or pelvic tumours. The pathogenesis in the present case was probably the following: Blunt, repeatedly used injection needles resulted in counter punctures and injury to the vein wall due to Sudden movement of the child's limb giving rise ~o a h a e m a t o m a which subsequently got infected to form an
MARYA ET AL.--AN UNUSUAL COMPLICATIONOF FEMORAL VENEPUNCTURE abscess.
Thus
the
p r o c e d u r e of
femoral
v e i n p u n c t u r e should be c o n d e m n e d as a routine,
However,
in a
dire
emergency
necessitating femoral venepuncture, meticulous asepsis should b e observed, m o v e m e n t of the l i m b c o m p l e t e l y restricted, a sharp short-bevelled n e e d l e p u n c t u r e s avoided.
used
and repeated
References
Asnes, R.S. and Arendar, G.M. (1966). Septic arthritis of the hip as a complication of femoral
23
venepuncture. Pediatrics, 38, 83 7. Geldbloom, R.B., Hillman, D.A. and Santulli T.V. (1967). Arterial thrombosis following femoral venepuncture in oedematous nephrotic children. Pediatrics, 40, 450. Matalon, R.(1970) Intermittent haemodiaiy~is with repeated femoral venepuncture. J.A.M.A. 214, 1883. McKay, R.J. (1967). Thrombosls of femoral artery following femoral venepuncture. Pediatrics, 40 319. Polesky, R.E. and Harvey, Paul, J. 0968). Gangrene of the extremity following femoral venepuncture; a report of two cases. Pediatrics, 42, 676.
22, 1977
P E R I V E S I C A L ABSCESS: A N U N U S U A L C O M P L I C A T I O N OF F E M O R A L VENEPUNCTURE* Report of a Case
S.K.S. MARYA, SttAVINDER KUMAR AND NEERAJ GAUR Rohtak
Femoral venepunclure is widely practised for raking blood samples for investigations and parenteral administration of drugs and fluids in collapsed patients, especially infants and children. Various complications like local sepsis, h a e m a t o m a formation, arterial damage, vascular thrombosis (Goldbloom a al. 1967) and gangrene of the limb (Polesky and Harvey 1968) have been recorded, following repeated puncture of the femoral vein. T h e following report of a case illus1rates a potentially severe and probably unreported complication of femoral venepuncture. Report of a Case
R.K., a 5-month-old child, was admitted to the paediatrics ward with dehydration due to diarrhoea of two days' duration for which the femoral veins were repeatedly punctured for taking blood samples and for administration of fluids. During his stay in the hospital, the patient developed a high grade fever and a mass in the hypogastrium for which he was referred to the surgical department. Rectal examination revealed a boggy swelling on the left side. Intravenous pyelography and cyslography showed that the urinary bladder was pushed to the right side. Keeping in mind the provisio*From the Department of Surgery, Medical College, Rohtak. Received on August 31, 1976.
nal diagnosis of pelvic abscess, an exploratory laparotomy was carried out. There was no intraperitoneal pathology. A needle aspiration of the mass, after closing the peritoneum, revealed frank pus which was drained extraperitoneally. Discussion
This report illustrates the occurrence of a perivesical abscess as one of the rare but dangerous complications of repeated femoral vein puncture. Many other complications of femoral venepuncture, such as arterial thrombosis (Goldbloom et al. 1967, M c K a y 1967), gangrene of the extremity (Polesky 1968), vascular thrombosis and embolism (Matalon 1970) and septic arthritis of the hip (Ashes 1966), have been reported. However, in the available English literature, we have not come across perivesical abscess being reported as a complication of femoral venepuncture. T h e condition reported herein may be confused with various other pathological conditions, e.g. pelvic abscess, infected diverticulum of the urinary bladder, saero-eoccygeal teratoma or pelvic tumours. The pathogenesis in the present case was probably the following: Blunt, repeatedly used injection needles resulted in counter punctures and injury to the vein wall due to Sudden movement of the child's limb giving rise ~o a h a e m a t o m a which subsequently got infected to form an
MARYA ET AL.--AN UNUSUAL COMPLICATIONOF FEMORAL VENEPUNCTURE abscess.
Thus
the
p r o c e d u r e of
femoral
v e i n p u n c t u r e should be c o n d e m n e d as a routine,
However,
in a
dire
emergency
necessitating femoral venepuncture, meticulous asepsis should b e observed, m o v e m e n t of the l i m b c o m p l e t e l y restricted, a sharp short-bevelled n e e d l e p u n c t u r e s avoided.
used
and repeated
References
Asnes, R.S. and Arendar, G.M. (1966). Septic arthritis of the hip as a complication of femoral
23
venepuncture. Pediatrics, 38, 83 7. Geldbloom, R.B., Hillman, D.A. and Santulli T.V. (1967). Arterial thrombosis following femoral venepuncture in oedematous nephrotic children. Pediatrics, 40, 450. Matalon, R.(1970) Intermittent haemodiaiy~is with repeated femoral venepuncture. J.A.M.A. 214, 1883. McKay, R.J. (1967). Thrombosls of femoral artery following femoral venepuncture. Pediatrics, 40 319. Polesky, R.E. and Harvey, Paul, J. 0968). Gangrene of the extremity following femoral venepuncture; a report of two cases. Pediatrics, 42, 676.
