COMPLICATIONS OF THE PUMP POCKET MAY REPRESENT A SIGNIFICANT CAUSE OFINCIDENTS WITH IMPLANTED SYSTEMS FOR INTRAPERITONEAL INSULIN DELIVERY

OBJECTIVE- To increase awareness of adverse events associated with the use of programmable implantable pumps (PIPs). CASES- There were 7 cas es of complications associated with the pump-pocket among 40 patients treated by PIP, and we searched for risk factors. RESULTS- Seven of 40 type I diabetic patients treated by PIP presented severe complication s of the pump-pocket, resulting in five definitive explantations and n ine other surgical interventions. The lesions included an exudative re action in the pump-pocket and a skin retraction or atrophy, which were complicated by skin erosion in five patients. Coagulase-negative stap hylococcus was identified in the pump-pocket in four patients, includi ng three cases of skin erosion. No specific risk of local complication s could be attributed to age, sex, duration of diabetes, body mass ind ex, presence of retinopathy or peripheral neuropathy, HbA(1c) level si nce implantation, depth of implantation in the abdominal wall, or dura tion of experience with PIP. Usual physical activity corresponding to >2,000 kcal energy expenditure per week, estimated by a questionnaire, appeared to be the only identified significant risk factor. CONCLUSIO NS- From these results, we suggest that physical activity should be li mited to moderate exercise and exclude vigorous efforts in diabetic pa tients treated by PIP to avoid an increased risk of complications at t he implantation site.