Propofol extravasation via a peripherally inserted central catheter mimicking a chylous fistula during neck dissection

Abstract

The use of peripherally inserted central catheters (PICCs) in oncological patients offers advantages but carries risks. We present the case of a male patient with laryngeal squamous cell carcinoma scheduled for a total laryngectomy and neck dissection. Following anesthetic induction, a PICC was inserted. During the dissection of left neck level IV, leakage of a milky fluid adjacent to the internal jugular vein (IJV) was observed, suggesting a thoracic duct injury (chylous fistula). After unsuccessful ligation attempts to control the leakage, an anomalous whitish discoloration was noted on the IJV wall. PICC malposition was suspected; following an ineffective partial withdrawal, further manipulation necessitated the ligation and transection of the IJV. The catheter tip was confirmed to be lodged within the transected vessel. The fragments were removed, and the venous stumps were ligated, resolving the complication.