Umbilical Artery Catheter-Associated Perianal Ischemia in a Preterm Infant

Severe ischemic complications following umbilical arterial catheterization (UAC) in preterm neonates are well recognized but almost invariably occur during placement or while the catheter remains in situ. We report a male infant born at 25 weeks’ gestation in whom bilateral crescent-shaped zones of full-thickness perianal necrosis (each ≈3 × 1 cm) developed within hours of uncomplicated removal of a correctly positioned UAC. This report describes severe, isolated perianal necrosis developing within hours of uneventful extraction of a well-positioned UAC. This case highlights that serious ischemic complications are not confined to catheter dwell time or malposition and may be precipitated by removal itself in the presence of immature collateral circulation and transient coagulopathy.