S3027 Breast Milk Fistula: An Unusual Complication of Therapy for Gastroparesis

Abstract

INTRODUCTION: We report an unusual medication related complication that developed in a patient being treated for chronic idiopathic gastroparesis. CASE DESCRIPTION/METHODS: The patient, a 40-year-old female, has a long history of idiopathic gastroparesis. Symptoms have been present for many years and in the past resulted in weight loss and numerous hospital visits. Gastric emptying scans have been markedly abnormal and on endoscopic examination residual old food was always present in the stomach. She had been evaluated for a possible gastric pacemaker and she has had pyloric Botox injections, pyloric dilation and has been treated with metoclopramide and more recently with domperidone for the last few years. She had also had a Nissen fundoplication for chronic reflux associated with gastric stasis. Her condition has remained stable for many months and she has gained weight and not required hospital visits. She presented to a breast surgeon with a recurrent chronic right breast abscess with overlying necrotic skin. Breast exam revealed no nipple discharge at that time, and she went to surgery for exploration, drainage and debridement. One week post procedure she complained of malodorous drainage from the incision and serous drainage was noted on the dressing. Wound culture was obtained and grew rare Streptococcus anginosis. The patient was started on Bactrim and a wick and plain packing was placed. Eleven days later she presented to the emergency room with complaints of malodorous drainage and right breast pain. Ultrasound revealed 3.1 × 0.7 × 3.5 cm complex fluid collection. Culture grew rare gram-positive cocci in pairs. She was treated with clindamycin and discharged home. She was reevaluated by the surgeon and new left nipple drainage was noted. Wound healing remained impaired. This raised the question of a milk fistula. The patient was instructed to stop taking domperidone. Over the next weeks the wound closed and there was no further drainage. She subsequently resumed her domperidone. DISCUSSION: Galactorrhea can be an uncommon side effect of domperidone. In this case it led to an unusual complication of breast wound milk fistula delaying healing of an abscess.