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Ghritlaharey RK. Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis. World J Clin Pediatr 2023; 12:331-349. [PMID: 38178931 PMCID: PMC10762601 DOI: 10.5409/wjcp.v12.i5.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/04/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt (VPS) catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion. AIM To identify the demographics, clinical presentation, clinical findings, and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter, clinically presented with or without trans-oral extrusion. METHODS An online search was performed for the extraction/retrieval of the published/ available literature pertaining to the above-mentioned VPS complication. Manuscripts were searched from PubMed, PMC (PubMed Central), ResearchGate, and Google Scholar databases using various terminology relating to the VPS complications. The first case of migration of a VPS catheter into the stomach was reported in the year 1980, and the data were retrieved from 1980 to December 2022. Cases were categorized into two groups; Group A: Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same, and Group B: Cases who had migration of the distal VPS catheter into the stomach, but presented without trans-oral extrusion. RESULTS A total of n = 46 cases (n = 27; 58.69% male, and n = 19; 41.3% females) were recruited for the systematic review. Group A included n = 32, and Group B n = 14 cases. Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the (n = 22) cases. Approximately sixty percent (n = 27) of them were children ≤ 5 years of age at the time of the diagnosis of the complication mentioned above. In seventy-two percent (n = 33) cases, this complication was detected within 24 mo after the VPS insertion/last shunt revision. Clinical diagnosis was evident for the entire group A cases. Various diagnostic modalities were used to confirm the diagnosis for Group B cases. Various surgical procedures were offered for the management of the complication in n = 43 cases of both Groups. In two instances, intra-gastric migration of the distal VPS catheter was detected during the autopsy. This review documented four deaths. CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups. It was more frequently reported in children, although also reported in adults and older people. A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without trans-oral extrusion.
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Affiliation(s)
- Rajendra Kumar Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal 462001, Madhya Pradesh, India
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Morinaga T, Nakahara O, Tsuji A, Kuramoto K, Iizaka M, Hayashida S, Ohya Y, Hitoshi Y, Inomata Y. Laparoscopic intervention for late-onset perforating peritonitis due to a ventriculoperitoneal shunt: a case report and literature review. Surg Case Rep 2023; 9:154. [PMID: 37665490 PMCID: PMC10477156 DOI: 10.1186/s40792-023-01737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunt placement is commonly performed to treat hydrocephalus and complications are not uncommon. We report here a case of generalized peritonitis caused by migration of the abdominal end of a VP shunt catheter into the bowel after multiple VP shunt revisions over 30 years. Laparoscopic surgery was successfully performed for the peritonitis and the VP shunt system subsequently reconstructed without complications. CASE PRESENTATION The patient was a 49-year-old woman who had a VP shunt placed for obstructive hydrocephalus at the age of 13 years. The shunt system required seven revisions because of various malfunctions, including two occasions where a nonfunctioning shunt catheter was left inside the abdomen for safety reasons. Approximately 1 year after the seventh revision, she developed abdominal pain and fever. Abdominal computed tomography suggested that the shunt catheter had migrated into the small intestine and caused an intra-abdominal abscess. We performed emergency exploratory laparoscopy, which revealed perforation of the small intestine by the tip of a nonfunctioning shunt catheter. A growing abscess was found around the perforated intestinal wall, causing bacterial ascites. After the functioning shunt catheter was pulled out from the abdomen, the nonfunctioning catheter that had perforated the intestinal wall was removed. The functioning shunt catheter was then connected to the cerebrospinal fluid drainage system to manage her severe hydrocephalus. Finally, the contaminated abdominal cavity was copiously irrigated with saline solution and a peritoneal drain placed. Twenty-five days later, she underwent another VP shunt surgery in which a VP shunt catheter was placed. She was discharged 45 days after the surgery for peritonitis without complications. CONCLUSION In cases of peritonitis with a history of VP shunt placement, perforation by a VP shunt catheter is possible, though rare. A delay in treatment could lead to a potentially fatal complication, such as septic shock. Laparoscopic surgery enabled a faster, more hygienic, and minimally invasive operation for managing this rare but serious complication of VP shunt placement.
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Affiliation(s)
- Takeshi Morinaga
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Osamu Nakahara
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan.
| | - Akira Tsuji
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Kunitaka Kuramoto
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Masayoshi Iizaka
- Department of Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Shintaro Hayashida
- Department of Pediatric Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Yuki Ohya
- Department of Pediatric Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Yasuyuki Hitoshi
- Department of Neurosurgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
| | - Yukihiro Inomata
- Department of Pediatric Surgery, Kumamoto Rosai Hospital, 1670 Takehara-Machi, Yatsushiro-City, Kumamoto, 866-8533, Japan
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Morosanu C, Nicolae L. Gastrointestinal complications following ventriculoperitoneal shunt insertion for pediatric hydrocephalus. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_190_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Morosanu CO, Priscu A, Florian IS. Evaluation of the ventriculocholecystic shunt-an overview of present practice in adult and pediatric hydrocephalus. Neurosurg Rev 2021; 44:2533-2543. [PMID: 33481136 PMCID: PMC8490219 DOI: 10.1007/s10143-021-01472-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/14/2023]
Abstract
In the context of hydrocephalus, there are a multitude of therapeutic options that can be explored in order to improve patient outcomes. Although the peritoneum is the current elected clinical solution, various receptacles have been utilized when experiencing contraindications. Along with the ventriculoatrial or ventriculopleural, the ventriculocholecystic shunt was also described as an alternative. In order to make a decision on a place for drainage, the surgeon must be knowledgeable on details from modern literature. The main target of this review was to summarize the currently available information on this topic and assess the status of the gallbladder as a viable option for cerebrospinal fluid diversion.
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Affiliation(s)
| | - Adelina Priscu
- Department of Internal Medicine, Indiana University Health Ball Memorial Hospital, Muncie, IN, USA
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5
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Ricci C, Velimirovic BM, Fitzgerald TN. Case report of migration of 2 ventriculoperitoneal shunt catheters to the scrotum: Use of an inguinal incision for retrieval, diagnostic laparoscopy and hernia repair. Int J Surg Case Rep 2016; 29:219-222. [PMID: 27883967 PMCID: PMC5122702 DOI: 10.1016/j.ijscr.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022] Open
Abstract
A ventriculoperitoneal shunt catheter migrated through an inguinal hernia into the scrotum. A single incision was used to for diagnostic laparoscopy, catheter removal and hernia repair. Prompt surgical removal of fractured shunt catheters is recommended to prevent organ injury. Backgroud Ventriculoperitoneal shunts are commonly used in the treatment of hydrocephalus, and catheter migration to various body sites has been reported. Pediatric and general surgeons are asked on occasion to assist with intraabdominal access for these shunts, particularly when there may be extensive adhesions or other complicating factors. Methods We describe a case in which an old shunt catheter was never removed from the abdomen, and it migrated through an inguinal hernia into the scrotum. The catheter became entangled and fibrosed to the testicle. A second and more recent shunt catheter was also in the scrotum. A single incision in the inguinal region was used to remove both shunt catheters, repair the inguinal hernia and perform diagnostic laparoscopy to assist in placing a new ventriculoperitoneal shunt. Results Prompt surgical removal is recommended for catheters remaining in the abdomen after ventriculoperitoneal shunt malfunction. These catheters may cause injury to the testicle, or possibly other intraabdominal organs. General or pediatric surgical consultation should be obtained for lost catheters or inguinal hernias. Conclusion In the case of an inguinal hernia containing a fractured shunt catheter, the hernia sac can be used to remove the catheter, repair the hernia and gain laparoscopic access to the abdomen to assist with shunt placement.
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Affiliation(s)
- Caesar Ricci
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA
| | | | - Tamara N Fitzgerald
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA.
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Neiter E, Guarneri C, Pretat PH, Joud A, Marchal JC, Klein O. [Semiology of ventriculoperitoneal shunting dysfunction in children - a review]. Neurochirurgie 2015; 62:53-9. [PMID: 26657112 DOI: 10.1016/j.neuchi.2015.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 08/24/2015] [Accepted: 10/10/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Ventriculoperitoneal shunting (VPS) is a treatment of the hydrocephalus that may dysfunction. The clinical presentation of shunt dysfunction is variable. We therefore decided to focus on the clinical presentation of VPS malfunction in children, as this condition requires immediate emergency treatment and because of the sometimes confusing signs of intracranial hypertension in a shunted child. MATERIALS AND METHODS We searched PubMed with the following groups of keywords: (dysfunction OR blockage) AND shunting AND hydrocephalus; shunt complications AND hydrocephalus; hydrocephalus AND shunt AND malfunction. Articles dealing with ventriculo-atrial shunt were excluded. A total of 79 articles were retained for analysis (English and French). Case reports were excluded. RESULTS The clinical presentation varies by age: vomiting and alterated level of consciousness are the most frequent signs in older children, whereas infants present more often with raised intracranial pressure symptoms such as nausea, vomiting, irritability and bulging fontanel. Drowsiness is a good predictor of VPS dysfunction. An asymptomatic presentation is rare but possible. Abdominal presentation is also possible, ranging from abdominal discomfort to peritonitis. Fever, occurring a short time after the last intervention, and irritability are good predictors of shunt infection. Pumping the chamber of the VPS has a weak positive predictive value (12%). Shunt dysfunction can lead to death, with an estimated mortality rate at 1% per year during the first years. CONCLUSION It is essential to be aware of the variability of the clinical presentation of VPS dysfunction, because of the potential severity of this condition. Also it is important to pay attention to the comments of the parents, especially if the child experienced a previous shunt malfunction.
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Affiliation(s)
- E Neiter
- Service de neurochirurgie pédiatrique, hôpital d'Enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - C Guarneri
- Service de neurochirurgie, hôpital Jean-Minjoz, CHU de Besançon, 25000 Besançon, France
| | - P-H Pretat
- Service de neurochirurgie pédiatrique, hôpital d'Enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - A Joud
- Service de neurochirurgie pédiatrique, hôpital d'Enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - J-C Marchal
- Service de neurochirurgie pédiatrique, hôpital d'Enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France
| | - O Klein
- Service de neurochirurgie pédiatrique, hôpital d'Enfants, CHU de Nancy, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France.
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Oktay K, Erkoc YS, Ethemoglu KB, Olguner SK, Sarac ME. Spontaneous Extrusion of Ventriculoperitoneal Shunt Catheter through the Right Lumbar Region: A Case Report and Review of the Literature. Pediatr Neurosurg 2015; 50:336-8. [PMID: 26458143 DOI: 10.1159/000439353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/09/2015] [Indexed: 11/19/2022]
Abstract
Ventriculoperitoneal shunt surgery is the most frequently performed procedure in the management of hydrocephalus. Many varied complications related to this procedure have been reported. Distal migration of the peritoneal catheter and extrusion from the intact skin in an area unrelated to the surgical incision constitute a rare complication. We report a 1-year-old patient with the extrusion of the peritoneal catheter from the intact skin in the right lumbar region and present a literature review.
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Lee BS, Vadera S, Gonzalez-Martinez JA. Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review. Int J Surg Case Rep 2014; 6C:198-202. [PMID: 25553524 PMCID: PMC4334951 DOI: 10.1016/j.ijscr.2014.09.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 09/24/2014] [Indexed: 12/20/2022] Open
Abstract
Cases of scrotal migration of distal catheter in adults are rare. There have been no reports for scrotal migration in adults at an early onset. Early detection of migration of distal catheter prevents shunt malfunction. Prompt surgical management of catheter repositioning is recommended. Introduction The role of shunt placement is to divert cerebrospinal fluid from within the ventricles to an alternative location in the setting of hydrocephalus. One of the rare shunt complications is distal catheter migration, and various body sites have been reported, including the scrotum. Although cases of scrotal migration of distal catheter have been reported in pediatric patients, cases in adult patients are rare due to obliterated processus vaginalis. Furthermore, there has not been a case reported for scrotal migration in an adult at an early onset. Presentation of case 65-year-old male underwent shunt placement for normal-pressure hydrocephalus-like symptoms. On post-operative day seven patient developed right testicular edema, for which ultrasound was performed, revealing hydrocele along with the presence of distal catheter in the scrotum. On post-operative day nine patient underwent distal catheter trimming via laparoscopic approach with general surgery, with post-operative imaging showing satisfactory location of distal catheter in the peritoneal cavity. Discussion/Conclusion Early onset of distal catheter migration into scrotum in an adult male is a unique case, as most cases are reported in pediatric patients, and it is the first case reported in the English literature to have occurrence at an early onset during the peri-operative period. As our case demonstrates, early occurrence and detection of scrotal migration of the distal catheter prevent shunt malfunction. Prompt surgical management of catheter repositioning is therefore recommended to avoid the risk of further complications.
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Affiliation(s)
- Bryan S Lee
- Cleveland Clinic Foundation, Department of Neurological Surgery, United States
| | - Sumeet Vadera
- Assistant professor of neurosurgery, University of California, Irvine, 101 The City Drive, Bldg 200, Suite 210 Orange, CA 92868, United States
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9
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Butler L, Keys C, Lam JPH. Bladder calculus formation on the tip of a migrated disused ventriculoperitoneal shunt. J Pediatr Surg 2013; 48:E1-3. [PMID: 23701800 DOI: 10.1016/j.jpedsurg.2013.02.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/07/2013] [Accepted: 02/12/2013] [Indexed: 12/17/2022]
Abstract
Bladder stones in children are rare. They generally occur in children with one or more predisposing risk factors to stone formation. In this unique case report we discuss the formation and successful endoscopic treatment of a large stone in a neuropathic bladder on the tip of a migrated VP shunt.
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Affiliation(s)
- Laura Butler
- Department of Paediatric Surgery, Royal Hospital for Sick Children, EH9 1LF, Edinburgh, United Kingdom
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10
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Unusual complications and mechanism: migration of the distal catheter into the heart--report of two cases and review of the literature. Childs Nerv Syst 2012; 28:1959-64. [PMID: 22648078 DOI: 10.1007/s00381-012-1814-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/16/2012] [Indexed: 10/28/2022]
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Hai A, Rab AZ, Ghani I, Huda MF, Quadir AQ. Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature. J Indian Assoc Pediatr Surg 2011; 16:31-3. [PMID: 21430848 PMCID: PMC3047774 DOI: 10.4103/0971-9261.74521] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report two cases of gastrointestinal perforation by ventriculoperitoneal (VP) shunts and review the literature on the topic. The time interval between shunt surgery and detection of bowel perforation is minimum in infants and increases with age. Sigmoid and transverse colon followed by stomach are the most frequent sites of gastrointestinal perforations by VP shunts.
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Affiliation(s)
- Abdul Hai
- Department of Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Pohlman GD, Wilcox DT, Hankinson TC. Erosive bladder perforation as a complication of ventriculoperitoneal shunt with extrusion from the urethral meatus: case report and literature review. Pediatr Neurosurg 2011; 47:223-6. [PMID: 22222434 DOI: 10.1159/000334277] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 09/25/2011] [Indexed: 12/14/2022]
Abstract
Ventriculoperitoneal (VP) shunt surgery is the most common technique used in the treatment of hydrocephalus. Erosive bladder perforation is an extremely rare complication of VP shunt surgery. Only 2 cases of erosive bladder perforation by a peritoneal catheter have been reported in the English literature. The authors present the case of a 14-year-old male with a history of cerebral palsy, severe developmental delay and hydrocephalus who presented with VP shunt tubing protruding from his urethral meatus. The patient had no evidence of neurological change. The VP shunt had been last revised over 11 years prior to admission. Imaging demonstrated the VP shunt to be intact, but displaced inferiorly, with the ventricular catheter in the extracranial soft tissue of the neck and the peritoneal catheter passing into the abdomen, bladder, and out through the urethra. Shunt removal was achieved through a multidisciplinary approach, involving both neurosurgery and urology teams. The authors discuss other reported cases of perforation by a VP shunt, potential mechanisms, and considerations for management of this rare complication.
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Affiliation(s)
- Garrett D Pohlman
- Division of Urology, Anschutz Medical Campus, University of Colorado Denver, Aurora, CO 80045, USA.
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Kolić Z, Kukuljan M, Bonifačić D, Vukas D. CSF liver pseudocyst as a complication of a ventriculoperitoneal shunt. Wien Klin Wochenschr 2010; 122:641-4. [DOI: 10.1007/s00508-010-1474-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2010] [Accepted: 08/31/2010] [Indexed: 10/18/2022]
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Udayakumaran S, Beni Adani L. A bizarre reentry phenomenon of distal shunt tip causing shunt malfunction. Childs Nerv Syst 2010; 26:963-5. [PMID: 20076988 DOI: 10.1007/s00381-009-1073-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Accepted: 12/15/2009] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We report a bizarre presentation of a distal shunt malfunction in a 5-year-old child with a ventriculoperitoneal shunt. DISCUSSION The plain radiographs done as a workup for possible shunt malfunction demonstrated the distal shunt tip reentering the abdominal wall from inside the peritoneal cavity. We discuss the possible explanation for the phenomenon. CONCLUSION We conclude that the case is just another reminder of the fact that shunt malfunctions can have multiple presentations; hence, a regular follow-up with appropriate imaging and high index of suspicion is mandatory in preventing morbidities.
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Affiliation(s)
- Suhas Udayakumaran
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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15
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Rizk E, Dias MS, Verbrugge J, Boop FA. Intracardiac migration of a distal shunt catheter: an unusual complication of ventricular shunts. Report of 2 cases. J Neurosurg Pediatr 2009; 3:525-8. [PMID: 19485740 DOI: 10.3171/2009.2.peds08482] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Unusual complications of peritoneal shunts are a well-known occurrence. The authors present 2 cases of intracardiac migration of a distal shunt catheter, summarizing the diagnosis and management of each case. This complication seems to be a rare occurrence; the transgression of the jugular vein leading to intracardiac migration of a shunt catheter has been reported only 6 times previously. The authors highlight the importance of careful and proper placement of the distal peritoneal catheter during the tunneling process, in particular avoiding too deep a penetration of the shunt passer into the neck tissues and too medial a shunt passage near the sternal notch to avoid vascular structures.
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Affiliation(s)
- Elias Rizk
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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Sahin S, Shaaban AF, Iskandar BJ. Recurrent pneumonia caused by transdiaphragmatic erosion of a ventriculoperitoneal shunt into the lung. Case report. J Neurosurg 2009; 107:156-8. [PMID: 18459889 DOI: 10.3171/ped-07/08/156] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To the best of the authors' knowledge, this report represents the first description of a ventriculoperitoneal (VP) shunt that migrated into the chest cavity where it caused recurrent pneumonias. This 15-year-old boy with a history of hydrocephalus treated with VP shunt therapy as an infant presented with a 2-year history of chronic coughing and recurrent pneumonia. A high-resolution chest computed tomography scan revealed a right lower lobe infiltration and evidence of migration of the peritoneal shunt tubing through the diaphragm into the lung parenchyma. The catheter was pulled back into the peritoneal cavity via a simple abdominal incision. The patient's long-term outcome was excellent, and there was complete cessation of the pneumonia.
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Affiliation(s)
- Soner Sahin
- Department of Neurological Surgery, University of Wisconsin Hospital and Clinics, Madison 53792, USA
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Di Rocco C, Massimi L, Tamburrini G. Shunts vs endoscopic third ventriculostomy in infants: are there different types and/or rates of complications? A review. Childs Nerv Syst 2006; 22:1573-89. [PMID: 17053941 DOI: 10.1007/s00381-006-0194-4] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2005] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The decision-making process when we compare endoscopic third ventriculostomy (ETV) with shunts as surgical options for the treatment of hydrocephalus in infants is conditioned by the incidence of specific and shared complications of the two surgical procedures. REVIEW Our literature review shows that the advantages of ETV in terms of complications are almost all related to two factors: (a) the avoidance of a foreign body implantation and (b) the establishment of a 'physiological' cerebrospinal fluid (CSF) circulation. Both these kinds of achievements are particularly important in infants because of the relative high rate of some intraoperative (i.e. abdominal) and late (secondary craniosynostosis, slit-ventricle syndrome) shunt complications in this specific subset of patients. On the other side, the main factor which is claimed against ETV is the relatively high risk of immediate mortality and neurological complications. Clinical manifestations of neurological structure damage seem to be more frequent in infants, probably due to the more relevant effect of parenchymal and vascular damage in this age group; however, both the immediate mortality and neurological damage risk of ETV procedures should be weighted against the long-term mortality and the late neurological damage which is not infrequently described as a consequence of shunt malfunction and proximal shunt revision procedures. Infections are possible in both ETV and extrathecal CSF procedures, especially in infants. However, the incidence of infective complications is significantly lower in case of ETV (1-5% vs 1-20%). Moreover, different from shunting procedures, infections in children with third ventriculostomy have a more benign course, being generally controlled by antibiotic treatment alone.
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Affiliation(s)
- C Di Rocco
- Pediatric Neurosurgical Unit, Catholic University, Largo A. Gemelli, Rome, Italy.
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de Aquino HB, Carelli EF, Borges Neto AG, Pereira CU. Nonfunctional abdominal complications of the distal catheter on the treatment of hydrocephalus: an inflammatory hypothesis? Experience with six cases. Childs Nerv Syst 2006; 22:1225-30. [PMID: 16525849 DOI: 10.1007/s00381-005-0025-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2004] [Revised: 03/30/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The peritoneal cavity is the most common site of cerebrospinal fluid absorption in hydrocephalus treatment. Many distal catheter complications are the result of this type of treatment, and these have been extensively described in the neurosurgical literature. MATERIALS AND METHODS In our study, six cases of distal catheter migration with visceral perforation and/or extrusion are presented: three through the umbilicus, two through the scrotum, and one through the anus. An extensive review of the literature was performed. RESULTS The studies of peritoneal dialysis models for the treatment of chronic renal failure patients provide important data about solute absorption in the peritoneal cavity and reactivity of the peritoneal membrane. CONCLUSION This model, when compared to distal catheter complications on a ventriculoperitoneal (VP) shunt, presents similarities that could help understand the mechanism of the nonfunctional complications of the distal VP catheter (complication with functional shunt), providing valuable data to support an inflammatory mechanism.
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Affiliation(s)
- Humberto Belem de Aquino
- Neurology Department and Neurosurgery, Service of State University of Campinas, Campinas City, São Paulo, Brazil.
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Ferreira PR, Bizzi JJ, Amantéa SL. Protrusion of ventriculoperitoneal shunt catheter through the anal orifice. A rare abdominal complication. J Pediatr Surg 2005; 40:1509-10. [PMID: 16150364 DOI: 10.1016/j.jpedsurg.2005.05.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Masuoka J, Mineta T, Kohata T, Tabuchi K. Peritoneal Shunt Tube Migration Into the Stomach-Case Report-. Neurol Med Chir (Tokyo) 2005; 45:543-6. [PMID: 16247243 DOI: 10.2176/nmc.45.543] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 47-year-old man presented with repeated headache and feverishness 3.5 years after undergoing ventriculoperitoneal shunt surgery for normal pressure hydrocephalus secondary to subarachnoid hemorrhage. Abdominal computed tomography revealed that the peritoneal catheter was encased by fibrous tissue and the distal end of the catheter had migrated into the stomach. The diagnosis was spontaneous gastric perforation by the ventriculoperitoneal shunt. The fibrous tissue was expected to seal the very small gastric perforation, so the catheter was successfully extracted through a scalp incision without abdominal surgical intervention.
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Affiliation(s)
- Jun Masuoka
- Department of Neurosurgery, Faculty of Medicine, Saga University, Saga, Japan
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Chan Y, Datta NN, Chan KY, Rehman SU, Poon CYF, Kwok JCK. Extrusion of the peritoneal catheter of a VP shunt system through a gastrostomy wound. SURGICAL NEUROLOGY 2003; 60:68-9; discussion 70. [PMID: 12865019 DOI: 10.1016/s0090-3019(03)00027-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A variety of complications can occur following ventriculoperitoneal shunt. We report a case of extrusion of the catheter tip through the old scar of the percutaneous endoscopic gastrostomy (PEG) wound. CASE DESCRIPTION A 70-year-old male suffered from an intracerebral hemorrhage and then developed hydrocephalus. He required a ventriculoperitoneal shunt. This patient required a PEG for gastroenteric feeding. The PEG was removed 4 years after the insertion because of infection. The tip of the distal shunt tube extruded through the scar of the PEG wound 2 years later. CONCLUSION The catheter end of VP shunt can extrude through the weak point of an old PEG scar. This kind of complication should be brought to mind while performing abdominal surgery in patients with VP shunts.
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Affiliation(s)
- Yung Chan
- Department of Neurosurgery, Kwong Wah Hospital, 25 Waterloo Road, Kowloon, Hong Kong, ROC
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Worley G, Wiener JS, George TM, Fuchs HE, Mackey JF, Fitch RD, Oldham KT. Acute abdominal symptoms and signs in children and young adults with spina bifida: ten years' experience. J Pediatr Surg 2001; 36:1381-6. [PMID: 11528610 DOI: 10.1053/jpsu.2001.26375] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND/PURPOSE Diagnosis and management of the acute abdomen in patients with spina bifida (SB) can be problematic. There are at least 4 clinical factors that can predispose to the development of acute abdominal symptoms and signs, and patients with a thoracic level lesion can have a partially insensate abdomen. The authors analyzed their accumulated experience to determine the annual incidence of acute abdominal signs and symptoms in children and young adults with spina bifida, the differential diagnosis, the operative management, and the outcome. The pertinent literature was reviewed. METHODS Cases were ascertained during a 10-year period at 1 institution and reviewed retrospectively. RESULTS Twenty-two episodes of acute abdominal symptoms and signs in 19 children and young adults with SB were ascertained over 10 years at 1 institution, for an annual incidence of 0.74%. More patients had a thoracic level lesion (n = 12; 60%) than in the clinic population as a whole (27%; P =.04), but the gender distribution was similar (58% girls), as was the prevalence of ventriculoperitoneal shunts (VPS; 95%). The median age was 13 years (range, 1 year to 26 years). Hospitalization was necessary for 19 (86%) of the 22 episodes. The duration of symptoms before diagnosis was a median of 3 days (range, 1 to 14 days). Most patients (82%) presented with abdominal pain. Fever was present in 27%, shock in 23%, and peritoneal signs in 23%. There were 14 different final diagnoses, 10 (71%) of which were associated with a predisposing factor. Of the 22 episodes, 18 (82%) could be attributed to an underlying factor: (1) neurogenic bladder (9; 41%); (2) neurogenic bowel (3; 14%); (3) VPS (4; 18%); (4) complications from previous surgery (2; 9%). Thirteen patients (59%) underwent a total of 20 surgical procedures of 12 different kinds. Despite awareness of the complexities involved, 3 patients (14%) died: 1 from complications resulting from bladder perforation; 1 from urosepsis and shock; and 1 from peritonitis caused by VPS infection. CONCLUSION The differential diagnosis of the acute abdomen in patients with SB is broad, conditions requiring surgery are frequently diagnosed, and the mortality rate is substantial, despite aggressive management.
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Affiliation(s)
- G Worley
- Program in Neurodevelopmental Pediatrics and Division of Genetics and Metabolism, Department of Pediatrics, Duke University Medical Center, Durham, NC 27710, USA
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Abstract
Cerebral ventricular shunts are siphoning devices used to treat hydrocephalus. They are placed within cerebral ventricles and peripheral cavities such as the ventricular atrium or peritoneal cavity. Complications include obstruction of cerebral spinal fluid (malfunction) and infection. Morbidity and mortality rates are high when shunt malfunction and infection are not treated emergently. This report summarizes the physical examination of patients with ventricular shunts, reviews the type of shunts commonly used, discusses shunt malfunctions (causing overshunting or undershunting of cerebrospinal fluid) and infections, and makes recommendations concerning empiric antibiotic therapy for shunt infection. The technique of tapping a shunt is presented for management of patients with elevated intracranial pressure that does not respond to non-invasive maneuvers to lower the pressure.
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Affiliation(s)
- J F Naradzay
- Department of Emergency Medicine, Samaritan Medical Center, Watertown, New York, USA
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Kusano T, Miyazato H, Shimoji H, Hirayasu S, Isa T, Shiraishi M, Muto Y, Furukawa M. Surg Laparosc Endosc Percutan Tech 1998; 8:474-476. [DOI: 10.1097/00019509-199812000-00015] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Couldwell WT, LeMay DR, McComb JG. Experience with use of extended length peritoneal shunt catheters. J Neurosurg 1996; 85:425-7. [PMID: 8751627 DOI: 10.3171/jns.1996.85.3.0425] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The placement of a ventriculoperitoneal (VP) shunt is the current treatment of choice for diversion of cerebrospinal fluid associated with hydrocephalus. Although there are a host of reported potential abdominal complications related to the procedure, they are notably uncommon. The authors report their experience with the primary insertion of an extended length open-ended peritoneal tubing (120 cm) undertaken expressly to avoid the need for a lengthening procedure because of growth of the patient. In a review of new insertions of VP shunts using the extended length tubing over a 14-year period at Childrens Hospital of Los Angeles, a total 998 shunts were placed in 952 patients, with a mean follow-up period of 6.7 years. The patients experienced a total of 52 distal shunt revisions for a variety of malfunction etiologies. In patients ranging in age from premature neonate to 20 years, there was no increase in the distal complication rate, and specifically no complications were experienced that were directly related to the use of the extended length tubing. The authors conclude that the use of an extended length peritoneal shunt catheter is not associated with an increase in complications and eliminates the need to lengthen the peritoneal catheter for growth of the patient.
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Affiliation(s)
- W T Couldwell
- Division of Neurological Surgery, Childrens Hospital of Los Angeles, University of Southern California School of Medicine, USA
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Abstract
We report an unusual case of catheter extrusion through the external genitalia. between the labium majus and the labium minus, in a 6-month-old hydrocephalic baby. The event occurred 5 months after placement of a ventriculoperitoneal shunt.
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Affiliation(s)
- M Nagulic
- Neurosurgical University Hospital, University Clinical Center, Belgrade
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Di Roio C, Barth X. [Ventriculoperitoneal shunt and colonic obstruction]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1996; 15:1133-4. [PMID: 9180997 DOI: 10.1016/s0750-7658(96)89492-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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