Beyond Infection and Occlusion: Unusual CT Findings of Tunneled Peritoneal Catheters and Their Conservative Management

Permanent tunneled peritoneal catheters (PTPCs) provide an established option for symptom control in patients with recurrent ascites.Although adverse events are usually related to infection, hemorrhage, impaired drainage, or fluid leakage, less typical complications can occur.We describe two unusual PTPCassociated complications that resolved with conservative treatment while the catheters remained in place.Case 1 is a 57-year-old woman with metastatic breast cancer and peritoneal carcinomatosis who underwent PTPC placement for recurrent symptomatic ascites.The following day, she developed severe right shoulder pain, with CT showing cranial catheter migration and diaphragmatic contact.With continued ascites drainage, symptoms resolved completely despite unchanged catheter position at six-week follow-up.Case 2 is a 71-year-old man with metastatic cholangiocarcinoma who underwent PTPC placement for recurrent ascites.Ten days later, he developed extensive right thoracoabdominal swelling.CT showed a large epifascial and subfascial fluid collection caused by ascites leakage through the peritoneal entry site.Frequent small-volume drainage and contralateral positioning resulted in complete resolution without catheter removal.In clinically stable patients with a functioning catheter, even unusual mechanical complications may be successfully managed conservatively despite unusual imaging findings.To our knowledge, neither cathetertip-induced shoulder pain from diaphragmatic irritation nor such extensive subcutaneous ascites tracking has previously been reported with corresponding CT documentation.Catheter removal should be reserved for irreversible dysfunction, dislocation, or infection uncontrolled by antimicrobial therapy.PTPC-related complications do not necessarily require catheter removal.In clinically stable patients with a functioning catheter, even unusual mechanical complications may be successfully managed conservatively despite unusual imaging findings.