[Case of large vein perforation caused by pumping using central venous catheter revealed by postoperative CT]

A 72-year-old woman, 157 cm in height and weighing 45 kg, was scheduled for emergency surgery for acute abdomen suggestive of gastrointestinal perforation. During the procedure, a triluminal central venous catheter (CVC) was inserted via the left internal jugular vein; venous blood could be aspirated separately through its lumens. On attempting blood transfusion, we noticed that the opening of one the CVC lumen tips was blocked and blood pumping was thus performed to achieve rapid transfusion. Colostomy was then performed and the transverse colon resection surgery was completed. Postoperative CT revealed right-sided hemothorax, a mediastinal hematoma located in the anterior region, and extravascular findings of CVC. The CT findings suggested a perforation of the left internal jugular vein due to the catheter tip. In the present case, the intraoperative pumping performed to enable rapid blood transfusion was believed to have caused blood vessel perforation. After the intraoperative blood vessel perforation, the condition may have been aggravated by steroid use, amyloidosis, and blood vessel fragility, ultimately presenting the extravascular findings observed on CT. We thus believe that in cases where CVC is inserted via the left internal jugular vein, blood pumping in particular is believed to be dangerous. Although the risks of blood vessel perforation when using CVC are relatively low, the possibility of unexpected complications should be borne in mind.