Extravascular migration of a peripherally inserted central catheter into the retroperitoneum in a preterm infant

Extravasation or vascular erosion into the retroperitoneum is a rare complication of central venous lines in the neonate. We present a case of a premature infant with a history of stage III necrotizing enterocolitis and deep vein thrombus who experienced an acute deterioration while advancing on enteral nutrition post-operatively. Imaging revealed a large retroperitoneal fluid collection accompanied by hydronephrosis. The underlying cause was extravasation of parenteral nutrition from a lower extremity peripherally inserted central catheter. Lower extremity venous catheters, including peripherally inserted central cathers, carry a risk of complications. Whether abdominal surgery and venous thrombosis increases the risk of vascular erosion is an area for future investigation.