Colocutaneous fistula complicating Tenckhoff catheter placement for intraperitoneal chemotherapy

In view of the characteristic intra-abdominal spread of carcinoma of the colon and rectum [1-3], the use of intraperitoneal chemotherapy may offer an alternative to intravenous or oral drug therapy and even radiation therapy for recurrent disease [4,5]. Several investigators have demonstrated that intraperitoneal drug administration may result in portal vein levels ten to 20 times higher than those observed in peripheral venous blood samples [6]. Traditionally, intraperitoneal chemotherapy has been administered through the Tenckhoff catheter system which was originally developed for peritoneal dialysis in patients with acute or chronic renal failure [7,8]. We report a case of Tenckhoff catheter erosion into the colon with subsequent fistulization developing 20 days after intra-operative placement for intraperitoneal or "belly bath" chemotherapy; this complication occurred in a patient with locally recurrent colorectal adenocarcinoma in whom pelvic peritoneal implants without hepatic metastases were identified at reoperation. This complication of the Tenckhoff catheter system has not previously been reported in the surgical literature.