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Fernandez B, Gautier A, Koumaré IB, Fabre JM, Coubes P, Poulen G. Transcutaneous ventriculo-peritoneal shunt catheter extrusion with silent bowel perforation following digestive surgery: a case report. Br J Neurosurg 2024; 38:1456-1459. [PMID: 35174740 DOI: 10.1080/02688697.2022.2039373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/28/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022]
Abstract
This case report provides an account of transcutaneous ventriculo-peritoneal (VP) shunt extrusion with silent bowel perforation occurring 2 years post digestive surgery. A 22-year-old man treated since childhood for post-infectious hydrocephalus was referred to our neurosurgery department for an inflammatory wound to the right hypochondrium caused by an abandoned calcified VP shunt. This VP shunt was surgically removed without complications. The perforated bowel required no direct repair. Progress is favorable at 1 year follow-up.
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Affiliation(s)
- Benjamin Fernandez
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Haut-Lévêque Hospital, CHU Bordeaux, France
| | | | - Izoudine B Koumaré
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
| | | | - Philippe Coubes
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
- Institut de Génomique Fonctionnelle, Montpellier, France
- CNRS UMR5203, Montpellier, France
- INSERM U661, Montpellier, France
| | - Gaëtan Poulen
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
- Institut de Génomique Fonctionnelle, Montpellier, France
- CNRS UMR5203, Montpellier, France
- INSERM U661, Montpellier, France
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Atallah O, Badary A, Monib FA, Almealawy YF, Saleh A, Lioi F, Fathallah S, Sapkota A, Kundu M, Sanker V, Das JM. Ventriculoperitoneal shunt extrusion in pediatric patients, clinical patterns and therapeutic strategies: A scoping review. Surg Neurol Int 2024; 15:226. [PMID: 39108372 PMCID: PMC11301811 DOI: 10.25259/sni_215_2024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 01/31/2025] Open
Abstract
Background Ventriculoperitoneal shunts (VPSs) are frequently employed in neurosurgery to treat hydrocephalus, with a particular focus on pediatric patients. Although VPSs are commonly utilized, they are not exempt from difficulties, such as shunt extrusion. The main aim of this study is to enhance comprehension regarding the occurrence, causes contributing to, and consequences of VPS extrusion in pediatric patients. Methods A comprehensive search approach was implemented, including electronic databases, including PubMed, Google Scholar, and Scopus, to locate pertinent articles published between January 1950 and May 2023. The utilization of keywords such as "ventriculoperitoneal shunt" and "extrusion," "ventriculoperitoneal shunt" and "migration," and "ventriculoperitoneal shunt" and "perforation" was employed. Data on patient demographics, underlying diseases, origin of extrusion, presenting symptoms, treatment, and follow-up were gathered. Statistical studies were conducted to identify potential risk factors connected with the occurrence of shunt extrusion. Results A study analyzed 80 studies on 120 individuals with extruded VPS catheters. The majority of patients (55.8%) had symptoms such as cerebrospinal fluid leakage and irritation. Hydrocephalus was categorized into congenital (40%), obstructive (36.7%), and communicating (11.7%) groups. Catheter extrusion sites varied, with most from the anal or rectal site. Preoperative meningitis or peritonitis was present in 20% of patients. Treatments ranged from shunt removal to endoscopic third ventriculostomy, resulting in a 90% recovery rate, 1.7% mortality, and 5% follow-up loss. Conclusion Extrusion of the distal catheter in VPSs is a critical medical situation that necessitates urgent surgical intervention. The presence of an infection raises the likelihood of complications; hence, it is vital to promptly address the issue through the administration of antibiotics and the replacement of the shunt. Timely intervention enhances results.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Department of Neurosurgery, Klinikum Dessau, Dessau-Rosslau, Germany
| | - Fatma A. Monib
- House Officer, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Aalaa Saleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Francesco Lioi
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | | | - Apil Sapkota
- Department of Psychiatry, University of Birmingham, Birmingham, United Kingdom
| | - Mrinmoy Kundu
- Department of Neurosurgery, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Trivandrum, Kerala, India
| | - Joe M. Das
- Department of Neurosurgery, Imperial College Healthcare National Health Services Trust, Charing Cross Hospital, London, United Kingdom
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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: 2] [Impact Index Per Article: 1.0] [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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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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Najib C, Abdellaoui H, Othmane A, Abdelhalim M, Khalid K, Youssef B. Transoral protrusion of a ventriculo-peritoneal shunt catheter in an 8-month-Old. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2021.102112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Fauzi AA, Parenrengi MA, Wahyuhadi J, Subagio EA, Turchan A. Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient. FOLIA MEDICA INDONESIANA 2021. [DOI: 10.20473/fmi.v55i4.24515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.
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Lundy PA, Partington MD, Tuchek CA, Garcia DM. Intrathoracic migration of ventriculo-peritoneal shunt via Morgagni hernia. Childs Nerv Syst 2021; 37:345-347. [PMID: 33063133 DOI: 10.1007/s00381-020-04926-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
We present the case of a 5-month-old patient presenting with pleural migration of ventriculo-peritoneal shunt catheter who returned 2 months later with respiratory distress. Ultimately, the diagnosis of a Morgagni hernia was made. This diagnosis, though rare, should be entertained in certain clinical settings.
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Affiliation(s)
- Paige A Lundy
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA. .,The University of Kansas Health System, 3901 Rainbow Blvd Mail Stop 3021, Kansas City, KS, 66160, USA.
| | - Michael D Partington
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA.,Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri at Kansas City, Kansas City, MO, USA
| | - Chad A Tuchek
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA
| | - David M Garcia
- Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA.,Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri at Kansas City, Kansas City, MO, USA
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Feeney V, Ansar N, Donaldson-Hugh B, Alalade AF. Transoral Protrusion of a Ventriculoperitoneal Catheter Caused by Jejunal Perforation in an Adult: Rare Case Report and Review of the Literature. World Neurosurg 2020; 137:200-205. [PMID: 32058122 DOI: 10.1016/j.wneu.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although several complications after ventriculoperitoneal shunting (VPS) have been reported, transoral protrusion of a peritoneal catheter is a rare event. In the few reported cases from the literature, it is more common in pediatric patients. This case report describes the first adult in the literature with a transoral VPS protrusion after jejunal perforation. CASE DESCRIPTION A 58-year-old man with posttraumatic hydrocephalus was noted with the distal tubing of the VPS protruding from his mouth after he vomited. Radiologic imaging showed jejunal perforation of the distal part of the VPS. The VPS was initially externalized, and then removed. The patient remained stable. CONCLUSIONS We present a rare case of transoral protrusion of a peritoneal catheter 11 months after a VPS procedure and review of the literature through this article.
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Affiliation(s)
- Vincent Feeney
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
| | - Naufel Ansar
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
| | | | - Andrew F Alalade
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom.
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Ezzat AAM, Soliman MAR, Hasanain AA, Thabit MA, Elshitany H, Kandel H, Abdel-Bari SH, Ghoul AMF, Abdullah A, Alsawy MFM, Ghaleb AA, Al Menabbawy A, Marei AA, El Razik BA, Schroeder HWS, Marx S, Zohdi A, El Refaee E. Migration of the Distal Catheter of Ventriculoperitoneal Shunts in Pediatric Age Group: Case Series. World Neurosurg 2018; 119:e131-e137. [PMID: 30031953 DOI: 10.1016/j.wneu.2018.07.073] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation. METHODS Between 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified. RESULTS Of 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions. CONCLUSIONS Peritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases.
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Affiliation(s)
| | | | - Amr A Hasanain
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | | | - Haitham Kandel
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | | | - Ahmed Abdullah
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Ammar A Ghaleb
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Ahmed A Marei
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Sascha Marx
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Ahmed Zohdi
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
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Chugh A, Gotecha S, Amle G, Patil A, Punia P, Kotecha M. Abnormal Migration and Extrusion of Abdominal End of Ventriculoperitoneal Shunt: An Experience of Eight Cases. J Pediatr Neurosci 2018; 13:317-321. [PMID: 30271464 PMCID: PMC6144606 DOI: 10.4103/jpn.jpn_18_18] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Ventriculoperitoneal (VP) shunt is commonly used in the treatment of hydrocephalus. Migration and extrusion of the distal end of the VP shunt are relatively rarely occurring complications. Aim: To retrospectively analyze patients with extrusion of the abdominal end of ventriculoperitoneal shunts and evaluate the possible etiology and outcome. Settings and Design: All patients presenting with extrusion of lower end of the shunt were included. The variables collected were age, sex, site of extrusion, time duration of extrusion, presence of local infection, meningitis, shunt dependency, and treatment received. Contrast-enhanced computed tomography of brain was carried out in all patients to rule out retrograde migration of infection in the cranial cavity. Materials and Methods: Eight patients of abnormal migration and extrusion of lower end of VP shunt were included. Results: The distal end of VP shunt was extruded from the anus (n = 3), vagina (n = 2), and anterior abdominal wall (n = 3). In five of these patients, shunt catheter was draining cerebrospinal fluid (CSF), the children were afebrile and CSF was sterile. In three children with extrusion of the shunt through the abdominal wall, the shunt tract was infected. Two of these patients had abscess in the shunt tract, which required incision and drainage. Both these patients had meningitis with a growth of Streptococcus species from CSF. Seven patients required further CSF diversion such as endoscopic third ventriculostomy (n = 3) or placement of VP shunt (n = 4). Conclusion: Distal tip migration of VP shunt may prove to have potentially serious complications such as meningitis. A prompt and aggressive protocol of management is recommended.
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Affiliation(s)
- Ashish Chugh
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Sarang Gotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Gaurav Amle
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Anil Patil
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Prashant Punia
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Megha Kotecha
- Department of Ophthalmology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India
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Al Fauzi A, Suryaningtyas W, Wahyuhadi J, Parenrengi MA, Turchan A, Wijaya MC, Jonatan M, Mahyudanil, Setyono H. Upward migration and peroral extrusion of a peritoneal shunt catheter: Case report and review of the literature. Surg Neurol Int 2017; 8:178. [PMID: 28868190 PMCID: PMC5569403 DOI: 10.4103/sni.sni_138_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Various complications after ventriculoperitoneal (VP) shunt surgery have been reported, but peroral extrusion of peritoneal catheter is an extremely rare complication, and only 20 cases have been reported since 1987. The pathophysiology still remains unclear and the management is challenging. Case Description: A 5-year-old boy presented with a catheter coming out of his mouth. The boy had a posterior fossa tumor surgery and had VP shunt insertion 1 year earlier. Clinical signs and imaging studies showed that the distal end of the catheter had perforated the gaster and migrated upward and extruded through the mouth. Emergency removal of the shunt and proper treatment were done and he made uneventful recovery. Conclusion: Peroral extrusion of VP shunt is extremely rare. Clinicians should be aware of this complication. With early diagnosis and proper management, the prognosis for good recovery is excellent, with only two deaths being reported in the literature. Complication of shunt extrusion is difficult to avoid, but knowing the risk factors, pathophysiology and proper management will decrease the morbidity and mortality of such cases.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Wihasto Suryaningtyas
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - M Arifin Parenrengi
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Maria C Wijaya
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Michael Jonatan
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Mahyudanil
- Department of Neurosurgery, H. Adam Malik General Hospital, Medan, Indonesia
| | - Hanis Setyono
- Department of Neurosurgery, Medical Faculty, Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta, Indonesia
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Ghritlaharey RK. Review of the Management of Peroral Extrusion of Ventriculoperitoneal Shunt Catheter. J Clin Diagn Res 2016; 10:PE01-PE06. [PMID: 28050444 PMCID: PMC5198397 DOI: 10.7860/jcdr/2016/23372.8920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Peroral extrusion of peritoneal part of Ventriculoperitoneal Shunt (VPS) catheter is an extremely rare complication following VPS implantation. AIM To review the options available for the management of peroral extrusion of VPS catheter. MATERIALS AND METHODS PubMed, Medline, PMC (PubMed Central), Embase, Google scholar databases search was performed to retrieve the published/available data relating to the peroral extrusion of VPS catheter. The keywords employed were "peroral extrusion of ventriculoperitoneal shunt catheter", "transoral extrusion of ventriculoperitoneal shunt catheter", and "oral extrusion of ventriculoperitoneal shunt catheter". The maiden description of peroral extrusion of VPS catheter was reported in the year 1987, and the data relating to peroral extrusion of VPS were retrieved from that period to June 30, 2016, and those were available in English literature. RESULTS Twenty-two published manuscripts (n) were available on the topic relating to peroral extrusion of VPS catheter. All were cases and were included for the review. This review included n=10; 45.45% male and n=12; 54.54% female. All of them were reported in children below 12-year of the age, except two case reports in adult that occurred at the age of 27-year and 47-year, respectively. Overall, the mean age at the time of peroral extrusion of VPS catheter was 6.94 ± 10.87 years. The interval from VPS insertion or last shunt revision to the occurrence of peroral extrusion of VPS catheter ranged from 10-days to 10-year, with a mean of 20.31 ± 28.37 months. More than two-third (n=15; 68.18%) of the case occurred within one-year of VPS insertion/last shunt revision. Clinical diagnosis was obvious in all the cases due to peroral extrusion of VPS catheter. The site of perforation by the VPS catheter was stomach in 15, jejunum in 1, diaphragm/trachea in 1, while the site of bowel perforation was not mentioned in 5 cases. Surgical procedures opted by authors in order of frequency were: (a) removal of entire VPS catheter n=5; (b) removal of entire VPS catheter, and delayed re-VPS n=5; (c) removal of peritoneal catheter with or without External Ventricular Drainage (EVD), and revision of peritoneal catheter n=3; (d) removal of peritoneal catheter, with or without EVD, and VA shunt n=3; (e) removal of peritoneal catheter, EVD and delayed re-VPS n=2; (f) removal of entire VPS catheter, EVD and delayed re-VPS n=2; (g) removal of peritoneal catheter, EVD and others n=2. Two deaths are also reported during the management of peroral extrusion of VPS catheter. CONCLUSION Peroral extrusion of peritoneal part of VPS catheter is an extremely rare complication following VPS insertion, and most frequently observed in children, although also reported in adults. In more than two-third of the cases it occurred within one-year of the VPS placement or last shunts revision, so a close follow-up is a must during this period following VPS placement. Management of such a case depends upon many factors such as presence or absence of shunt tract infection, peritonitis, meningitis, and cerebro spinal fluid infection.
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Affiliation(s)
- Rajendra Kumar Ghritlaharey
- Professor and Head, Department of Pediatric Surgery, Gandhi Medical College and associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India
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Gupta M, Digra NC, Sharma N, Goyal S, Agrawal A. Peroral extrusion of the peritoneal catheter in an infant. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:290-2. [PMID: 22754883 PMCID: PMC3385368 DOI: 10.4103/1947-2714.97214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Peroral extrusion of the distal end of a ventriculo-peritoneal shunt tube is the potentially hazardous end result of a bowel perforation with only few case reports in the literature. The distal end of the peritoneal catheter got fractured in a 4-year-old child and it protruded out through the mouth. The cranial incision was opened and the shunt divided below the chamber. The ventricular end and the chamber and distal end were removed through this incision. In the present successfully managed case we review the current strategies in the management of such a rare complication and discuss the possible pathogenesis of this entity.
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Affiliation(s)
- Mahesh Gupta
- Department of Surgery, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Agarwal M, Adhana R, Namdev H, Yadav YR, Agrawal T. Transoral extrusion of the ventriculo-peritoneal shunt: A case report and review of literature. J Pediatr Neurosci 2012; 6:149-51. [PMID: 22408670 PMCID: PMC3296415 DOI: 10.4103/1817-1745.92847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
There are several case reports of complications of ventriculo-peritoneal shunt. Extrusion of the peritoneal end of the shunt through mouth is extremely rare. There are few case reports. We are reporting one such case. A 1-year male child was admitted with the peritoneal end of ventriculo-peritoneal shunt coming out through mouth since 6 hours after an episode of vomiting. He was conscious and had no neurological deficits. The anterior fontanelle was depressed. There was no infection. The peritoneal end of the shunt was removed through the mouth. Shunt revision was performed. The patient was discharged 10 days after the revision without any complications. At 1-year follow-up the patient is doing well. Possible mechanisms of bowel perforation are discussed. Pulling the peritoneal end through mouth is probably the best way of management as small spontaneous gut perforation seals off spontaneously. It also decreases the possibility of infection, other morbidities, and hospital stay.
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Affiliation(s)
- Moneet Agarwal
- Department of Neurosurgery, NSCB Medical College, Madhya 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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Sinnadurai M, Winder MJ. Silicone spaghetti. J Clin Neurosci 2009; 16:1348-50. [PMID: 19577477 DOI: 10.1016/j.jocn.2008.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 12/15/2008] [Indexed: 11/24/2022]
Abstract
Migration of ventriculoperitoneal shunt catheters, although infrequent, is well reported. We report the unusual event of a patient who, after having had three shunt revisions over a 15-year period, presented with a per-oral extrusion of her original distal catheter.
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Affiliation(s)
- Manohan Sinnadurai
- Neurosurgery, St Vincent's Hospital, 406 Victoria Street, Darlinghurst, New South Wales 2010, Australia.
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Mohindra S, Singla N, Gupta R, Gupta SK. CSF fistula through the umbilicus following a shunt surgery: a case report and literature review. Pediatr Neurosurg 2007; 43:396-398. [PMID: 17786005 DOI: 10.1159/000106389] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2006] [Accepted: 08/16/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Ventriculoperitoneal shunting is among the commonest neurosurgical operations. Shunt catheters within the peritoneal cavity have migrated through and perforated almost all the intra-abdominal hollow viscera. CASE DESCRIPTION A unique case of an infant is presented, in whom CSF leaked via a fistulous opening through the umbilicus. The embryological aspect of this anomalous communication is described, along with all the 7 cases previously reported with their pathophysiological causes. CONCLUSIONS The CSF fistula through the umbilicus may be due to varying pathological causes. The present paper describes an altogether new pathological cause behind such a complication, with a re-visit to all other described causes. The present description of a patent intercoelomic communication, an embryological remnant, puts a new light on this 3-decade-old complication.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Vinchon M, Baroncini M, Laurent T, Patrick D. Bowel perforation caused by peritoneal shunt catheters: diagnosis and treatment. Neurosurgery 2006; 58:ONS76-82; discussion ONS76-82. [PMID: 16543876 DOI: 10.1227/01.neu.0000192683.26584.34] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The peritoneum is the preferred site for insertion of shunts used for the treatment of hydrocephalus. Bowel perforation by peritoneal catheters (BPPC) is a rare but devastating complication. Its pathophysiology, diagnosis, and treatment are debated. METHODS Retrospective review of cases of BPPC in a series of 1956 patients having a peritoneal catheter followed up for a mean duration of 10.0 years. RESULTS Nineteen observations of BPPC, representing 1.0% of the total series. Nine of 19 patients were nonambulatory, and nine of 19 had a previous history of meningeal infection. At the time of diagnosis, only three of the 19 patients had anal extrusion of the catheter, 14 had fever, nine had abdominal signs and symptoms, and six had cutaneous signs of infection. Radiological investigations were often negative or inconclusive. In seven of the patients, the initial diagnosis was shunt failure, and BPPC was diagnosed only during shunt revision. Once the correct diagnosis was made, the treatment was total shunt removal, external drainage, and antibiotic therapy for 2 weeks. Three patients, all severely impaired before BPPC, died, one of meningeal sepsis, the others of multiorgan failure related to spastic tetraparesis. Three were considered shunt-independent, two had a ventriculoatrial shunt, and the others had a new shunt with a peritoneal catheter without complication. CONCLUSION BPPC is a neurosurgical emergency. Anal extrusion is present in only a minority of patients; the diagnosis of BPPC is often difficult, delayed, and its incidence is likely underestimated. The majority of patients can be treated with a new peritoneal shunt after cure of the infection.
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Affiliation(s)
- Matthieu Vinchon
- Department of Pediatric Neurosurgery, Centre Hospitalier Regional, University de Lille, Lille, France.
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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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21
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Abstract
We report a case of delayed intrapleural migration of the peritoneal catheter of a ventriculoperitoneal shunt. This is an unusual but life-threatening complication of peritoneal shunting for the treatment of hydrocephalus. A method of treatment and abbreviated review of shunt complications is included.
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Affiliation(s)
- M C Johnson
- Division of Pediatric Neurosurgery, Emanuel Children's Hospital, Portland, OR 97227, USA
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22
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Doh JW, Bae HG, Lee KS, Yun IG, Byun BJ. Hydrothorax from intrathoracic migration of a ventriculoperitoneal shunt catheter. SURGICAL NEUROLOGY 1995; 43:340-3. [PMID: 7792702 DOI: 10.1016/0090-3019(95)80059-p] [Citation(s) in RCA: 51] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The intrathoracic complications of the ventriculoperitoneal (VP) shunt are very rare. We report an unusual case of VP shunt complication with intrathoracic migration, associated with pleural effusion in a 55-year-old man. METHODS We reviewed the seven cases reported in the literature and the mechanism of shunt-tip migration and preventive measures are presented. RESULTS The patient was successfully managed with revision. The catheter was retrieved and replaced in the peritoneal cavity. CONCLUSIONS With VP shunting, it is important to keep in mind the possibility of peritoneal shunt-tip migration into the chest. To prevent this kind of complication, we stressed precise location of a subcutaneous tunneling device above the ribs during subcutaneous passage.
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Affiliation(s)
- J W Doh
- Dept. of Neurosurgery, Soonchunhyang University Chonan Hospital, Korea
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Chai WX. Long-term results of fourth ventriculo-cisternostomy in complex versus simplex atresias of the fourth ventricle outlets. Acta Neurochir (Wien) 1995; 134:27-34. [PMID: 7668122 DOI: 10.1007/bf01428498] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twelve cases of atresia of the fourth ventricle outlets are presented and they are classified into 2 types: simplex versus complex. Fourth ventriculo-cisternostomy is the treatment of choice. Based on the surgical experiences in simplex cases, new technical modifications were developed to make it applicable to the complex cases as well. The advantages and limitations of such operative approaches over other conventional shunt procedures are compared and the long-term postoperative results are listed. Hopefully, the surgical intervention described here may have opened a reasonable method for treating certain cases of the trapped fourth ventricle as a special variant of the complex atresia type. It is important to realize that knitted tubes are categorically unqualified for the surgical use like this.
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Affiliation(s)
- W X Chai
- Department of Neurosurgery, Beijing Friendship Hospital, Peoples Republic of China
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Ceylan S, Kuzeyli K, Kalelioğlu M, Aktürk F. Two unusual complications of ventriculo-peritoneal shunts. Report of two cases. Neurosurg Rev 1993; 16:233-5. [PMID: 8272213 DOI: 10.1007/bf00304335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Two cases in which thoracal extrusion and cervical disconnection complicated ventriculo-peritoneal shunts are reported. Other complications of distal shunts are also reviewed.
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Affiliation(s)
- S Ceylan
- Medical Faculty Department of Neurosurgery, Karadeniz Technical University, Trabzon, Turkey
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Mevorach RA, Hulbert WC, Merguerian PA, Rabinowitz R. Perforation and intravesical erosion of a ventriculoperitoneal shunt in a child with an augmentation cystoplasty. J Urol 1992; 147:433-4. [PMID: 1732610 DOI: 10.1016/s0022-5347(17)37260-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Bladder augmentation has evolved into a common method of management in children with a low capacity and/or poorly compliant bladder secondary to a neuropathic condition. We report on a 4-year-old girl with myelodysplasia who presented with sepsis and who had a perforation of the augmented bladder, which was surgically repaired. She returned for evaluation 1 month after she was discharged from the hospital when the distal component of the ventriculoperitoneal shunt was noted to protrude per urethram after clean catheterization. Distal shunt replacement with prolonged bladder drainage successfully resolved this perforation of the augmented bladder. The patient has had no further difficulties. We discuss the diagnosis and management of this case with reference to the current literature regarding complications of augmentation cystoplasty.
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Affiliation(s)
- R A Mevorach
- Department of Urology, University of Rochester Medical Center, New York 14642
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Ammar A, Ibrahim AW, Nasser M, Rashid M. CSF hydrocele--unusual complication of V-P shunt. Neurosurg Rev 1991; 14:141-3. [PMID: 1870720 DOI: 10.1007/bf00313040] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CSF hydrocele as a complication of migration or extrusion of the peritoneal end of the V-P shunt has rarely been reported. Here the case of a 6 month old infant, born at 28 weeks gestational age, is reported. The baby was noted to have scrotal swelling, exacerbated by crying, two months after insertion of ventriculoperitoneal shunt. The hydrocele resolved following revision of the shunt. Possible pathophysiological causes are discussed.
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Affiliation(s)
- A Ammar
- Department of Neurosurgery, College of Medicine and Medical Sciences, King Faisal University, Dammam, Saudi Arabia
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Sridhar K, Sharma BS, Kak VK. Spontaneous extrusion of peritoneal catheter through intact abdominal wall. Clin Neurol Neurosurg 1988; 90:373-5. [PMID: 2976629 DOI: 10.1016/0303-8467(88)90014-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A rare occurrence of spontaneous extrusion of a Denver peritoneal catheter through the right flank in a 14-year-old boy is reported. The firm texture and short length of the catheter coupled with its movements with respiration produced a hammer effect and eroded the abdominal wall. Disconnection of the peritoneal catheter from the chamber and pulling out the extruded catheter is suggested as a simple and effective method of removal of the shunt.
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Affiliation(s)
- K Sridhar
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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