Iatrogenic hemoperitoneum and sigmoid colon injury from malpositioned apomorphine infusion device in advanced Parkinson’s disease

Apomorphine pumps are increasingly used for the management of patients with advanced Parkinson's Disease. We report a unique case of hemoperitoneum and penetrating colonic injury resulting from malpositioning of a subcutaneous apomorphine device-a complication not previously described in the literature. Seventy-six-year-old man with advanced Parkinson's Disease presented with acute abdominal pain 3-hours post the re-siting of his apomorphine infusion device. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis revealed high-density fluid (47-67 Hounsfield Units), consistent with hemoperitoneum. Subsequent CT angiography revealed progressive bleeding and identified the infusion device penetrating the anterior sigmoid colon. The infusion set used was inappropriately long for the patient's anatomy, a major factor contributing to the complication. Patient-specific factors further increased the risk of bowel injury, including severe faecal loading with resultant stercoral colitis, minimal rectus abdominus musculature, and thin subcutaneous and preperitoneal fat, all of which was evident on CT imaging. The patient was managed conservatively based on consideration of comorbidities and frailty status, and made a full recovery. This case revealed a unique and rare iatrogenic injury resulting from a subcutaneous medication delivery device. Careful consideration of anatomical and patient-specific factors, along with appropriate device selection, is critical to preventing such complications.