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Abdelmageed S, Sarkar P, Shlobin NA, Davila DG, Potts MB. Laparoscopic-Assisted Peritoneal Access in Ventriculoperitoneal Shunt Placement: Systematic Review and Meta-Analysis. Neurosurgery 2025; 96:734-743. [PMID: 39465943 DOI: 10.1227/neu.0000000000003213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 08/02/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The most common treatment of hydrocephalus is ventriculoperitoneal (VP) shunting. Peritoneal access is commonly conducted through an open laparotomy, but laparoscopic peritoneal access is gaining popularity. Many studies have reported the benefits of minimally invasive laparoscopic peritoneal access, but there is no consensus on its use. We conducted a systematic review and meta-analysis to compare open laparotomy vs laparoscopic peritoneal access in VP shunting. METHODS A systematic search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using 3 databases. Twelve studies included only adults, 3 included only pediatric patients, and 3 included both adults and pediatric patients. RESULTS Compared with open laparotomy, laparoscopic peritoneal access was associated with a reduction in distal shunt failure (6.1% vs 2.2%, P = .01), operative time (69.4 vs 56.3 minutes, P < .001), and length of stay (LOS) (9.6 vs 7.3 days, P < .001). There were no differences in proximal shunt failure, total shunt failure, intraoperative complications, or infection rate. In the pediatric population, laparoscopic access was associated with a reduced LOS (7.8 vs 5.9 days, P < .001). Heterogeneity was high but explained by the varying study populations and techniques. CONCLUSION Laparoscopic peritoneal access for VP shunt insertion is associated with improved outcomes, including reduced distal shunt failure, reduced operative time, and reduced hospital LOS, when compared with open laparotomy and should be considered for shunt insertion. Additional studies are necessary to further determine the benefit of laparoscopic access, especially in the pediatric population.
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Affiliation(s)
- Sunny Abdelmageed
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Prottusha Sarkar
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Nathan A Shlobin
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
| | - Daniel G Davila
- Department of Surgery, Northwestern Medical Group, Lake Forest Hospital, Lake Forest , Illinois , USA
| | - Matthew B Potts
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
- Department of Surgery, Northwestern Medical Group, Lake Forest Hospital, Lake Forest , Illinois , USA
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA
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Shbani A, Zainabo A, Zainabo R, Alsayed C, Ranjous N. Complex complications following ventriculoperitoneal shunt placement in Syria: A case report on multiple bowel perforations, migration, and obstruction. Int J Surg Case Rep 2024; 124:110348. [PMID: 39332221 PMCID: PMC11460497 DOI: 10.1016/j.ijscr.2024.110348] [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: 08/03/2024] [Revised: 09/19/2024] [Accepted: 09/24/2024] [Indexed: 09/29/2024] Open
Abstract
INTRODUCTION In patients with hydrocephalus, the most effective technique since the early 1900s is through the implantation of a ventriculoperitoneal shunt (VPS). VPS can cause abdominal issues such as infection, bowel obstruction due to adhesions, or viscus perforation. In our patient, the combination of infection, bowel obstruction, multiple intestinal perforations, and anal migration of the shunt creates a unique blend of complications that may be caused by VPS. CASE PRESENTATION A 17-year-old girl with a history of ventriculoperitoneal shunt placement presented with symptoms of bowel obstruction. During the anal palpation, the examiner felt a tubular object inside the rectal ampulla which was the shunt. Laparotomy revealed that the shunt catheter had perforated the jejunum, extended through the sigmoid colon, and into the rectum. The patient was treated with antibiotics and an external shunt was placed for three months, then placed through the jugular vein to the pericardial cavity. DISCUSSION Hydrocephalus treatment often involves ventriculoperitoneal shunts (VPS) with complications such as abdominal issues, infections, and bowel perforation. These issues occur in 24 %-47 % of cases. In a rare case, a patient experienced infection, anal shunt migration, bowel obstruction, and three perforations, starting from the jejunum and extending to the rectum. The patient's history of appendectomy and previous shunt complications may have predisposed them to the perforation. CONCLUSION The rare combination of infection, anal shunt migration, a bowel obstruction, and a perforations during hydrocephalus treatment highlights the critical need for comprehensive understanding of and monitoring for ventriculoperitoneal shunt complications. Prompt interdisciplinary intervention is essential due to the potential severity and mortality associated with these complex issues. Specific patient factors must be considered to optimize patient outcomes.
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Affiliation(s)
| | - Asmaa Zainabo
- Tishreen University, Faculty of Medicine, Lattakia, Syrian Arab Republic
| | - Raghad Zainabo
- Tishreen University, Faculty of Medicine, Lattakia, Syrian Arab Republic
| | - Chaza Alsayed
- Department of Gastroenterology and Hepatology, Syrian Arab Republic
| | - Nazem Ranjous
- Department of General Surgery, Tishreen University, Lattakia, Syrian Arab Republic
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Khoury N, Paladiya R, Goldenberg S. Colonic Perforation from Ventriculoperitoneal Shunt Incidentally Found on Screening Colonoscopy. Dig Dis Sci 2024; 69:2713-2714. [PMID: 38831226 DOI: 10.1007/s10620-024-08477-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/03/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Neil Khoury
- University of Connecticut Health Center, Farmington, USA.
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Kashyap S, Singh SK, Gupta G. Scrotal migration of a ventriculoperitoneal shunt. BMJ Case Rep 2024; 17:e260380. [PMID: 39074949 DOI: 10.1136/bcr-2024-260380] [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] [Indexed: 07/31/2024] Open
Abstract
Ventriculoperitoneal shunt (VPS) is the most common procedure done for hydrocephalus in the paediatric population. While shunt infection and shunt malfunction remain the most common complications, shunt migration is not frequently observed. Being present in a large peritoneal cavity, theoretically, a shunt can travel to a variety of locations. Even among these, scrotal migration is quite uncommon. This case highlights the significance of keeping this possibility in mind while evaluating a case of shunt malfunction. It also discusses various nuances of surgically managing scrotal migration.
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Affiliation(s)
- Shalvika Kashyap
- Paediatric Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Santosh Kumar Singh
- Paediatric Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Javeed F, Tariq M, Butt H, Rehman L. Scrotal Migration of the Ventriculoperitoneal Shunt: A Case Report and Review of the Literature. Cureus 2024; 16:e63384. [PMID: 39070365 PMCID: PMC11283841 DOI: 10.7759/cureus.63384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Ventriculoperitoneal (VP) shunt placement is the most frequently used treatment for hydrocephalus. This procedure is not always free of complications, and patients may need additional surgeries to overcome these complications. We are presenting the case of a seven-month-old baby who underwent myelomeningocele repair and VP shunt placement 13 days ago and now presents with inguinal swelling extending into the scrotum. The radiological workup revealed that the peritoneal end of the VP shunt had migrated to the scrotum, causing hydrocele. The shunt was relocated to the abdomen after a right herniotomy and sac reduction. He was discharged on the second postoperative day without any complications, and the further recovery was good at three months. Scrotal migration of a VP shunt is a rare complication and can be avoided by careful early assessment of inguinal hernia or patent processus vaginalis and its surgical repair.
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Affiliation(s)
- Farrukh Javeed
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Maryam Tariq
- Neurosurgery, Karachi Medical and Dental College, Karachi, PAK
| | - Hiba Butt
- Neurosurgery, Karachi Medical and Dental College, Karachi, PAK
| | - Lal Rehman
- Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi, PAK
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Salih MSM, Sethuramachandran A, Bidkar PU, Dey A, R. G, Gunasekaran A, Chandar V. Comparison of Optic Nerve Sheath Diameter (ONSD) Measurements Obtained from USG Before and After Placement of Ventriculoperitoneal Shunt in Obstructive Hydrocephalus as a Surrogate Marker for Adequacy of Shunt Function: A Prospective Observational Study. Asian J Neurosurg 2024; 19:242-249. [PMID: 38974437 PMCID: PMC11226299 DOI: 10.1055/s-0044-1786701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction Optic nerve sheath diameter (ONSD) measured using ultrasonography has been widely used as a surrogate marker of elevated intracranial pressure. However, literature is sparse on the correlation between ONSD and ventriculoperitoneal (VP) shunt function, especially in adults with hydrocephalus. Our study was designed to assess the correlation between ONSD measured using ultrasonography before and 12 hours after VP shunt placement and the success of VP shunt placement assessed using computed tomography (CT) of the brain. Materials and Methods Fifty-one patients between 16 and 60 years of age, with obstructive hydrocephalus scheduled for VP shunt surgery were included in this prospective, observational study. ONSD measurements were obtained from both eyes prior to induction of anesthesia, immediately after the surgery, and at 6, 12, and 24 hours after the surgery. An average of three readings was obtained from each eye. Cerebrospinal fluid (CSF) opening pressure was noted after entry into the lateral ventricle. Noncontrast CT (NCCT) brain was obtained 12 hours after the surgery and was interpreted by the same neurosurgeon for signs of successful VP shunt placement. Results There was a significant reduction in ONSD in the postoperative period compared to ONSD measured preoperatively. The average ONSD (mean ± standard deviation) measured prior to induction of anesthesia, immediately after the surgery, and at 6, 12, and 24 hours after the surgery was 5.71 ± 0.95, 5.20 ± 0.84, 5.06 ± 0.79, 4.90 ± 0.79, and 4.76 ± 0.75 mm, respectively. The mean CSF opening pressure was 19.6 ± 6.9 mm Hg. Postoperative NCCT brain revealed misplacement of the shunt tip in only one patient. Conclusion ONSD measured using ultrasonography may be used as a reliable indicator of VP shunt function in adults with obstructive hydrocephalus.
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Affiliation(s)
- M. S. Mohamed Salih
- Department of Neuroanesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Adinarayanan Sethuramachandran
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prasanna Udupi Bidkar
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ankita Dey
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bathinda, Bathinda, Punjab, India
| | - Gopikrishnan R.
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Adethen Gunasekaran
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vivek Chandar
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Adel K, Fayçal A, Toufik B, Abdelhalim M. Bowel perforation and anal ventriculoperitoneal shunt migration: A systematic review. J Taibah Univ Med Sci 2024; 19:263-269. [PMID: 38234714 PMCID: PMC10792256 DOI: 10.1016/j.jtumed.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/08/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
Background One of the most feared complications of hydrocephalus is shunt migration. Although rare, bowel migration is the most commonly encountered type of migration. The relatively high frequency of this occurrence allowed us to gather a substantial number of reports for study. Objectives The aim of this study was to better understand this complication and aid in decreasing its incidence. Methods The PubMed and Scopus databases were searched for cases of anal shunt migration. In total, 49 records describing 56 clinical cases were included in this review. Additionally, we present and include the clinical case of a patient managed by our team; therefore, 57 cases were included in this study. Relevant parameters were collected, organized, analyzed, and discussed. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement from 2009. Results Extrusion through the anus was observed in 82% of cases, 68% of which were in males. The age range varied from 1 month to 75 years. Congenital hydrocephalus was the etiology in 66% of cases. The time interval between shunt insertion and migration varied from 12 days to 19 years. In 70% of patients, the tube was pulled out through the anus, whereas a laparotomy or laparoscopy was used in 14% of cases. Infectious complications were noted in 35% of patients. The overall outcome was mostly favorable; two patients died as a complication of the migration. Conclusions Bowel and anal shunt migration is a relatively rare complication occurring predominantly within the initial weeks after the initial surgery. This condition leads to infectious complications, which can potentially be life-threatening. Urgent management is required, and in most cases, the removal of the shunt through the anus is sufficient. Early intervention generally results in favorable outcomes.
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Affiliation(s)
- Khelifa Adel
- Department of Neurosurgery, Mohamed Lamine Debaghine University Hospital (BEO), Algiers, Algeria
| | - Aichaoui Fayçal
- Department of Neurosurgery, Mohamed Lamine Debaghine University Hospital (BEO), Algiers, Algeria
| | - Bennafaa Toufik
- Department of Neurosurgery, Mohamed Lamine Debaghine University Hospital (BEO), Algiers, Algeria
| | - Morsli Abdelhalim
- Department of Neurosurgery, Mohamed Lamine Debaghine University Hospital (BEO), Algiers, Algeria
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Hobbs E, Thompson DNP, Muthialu N, Silva AHD. Intracardiac migration of distal catheter-a rare complication of VP shunt insertion: case report and literature review. Childs Nerv Syst 2024; 40:587-591. [PMID: 37855877 PMCID: PMC10837212 DOI: 10.1007/s00381-023-06187-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023]
Abstract
Intracardiac migration is a rare complication of ventriculoperitoneal shunt insertion. Only 15 cases have been reported, 7 of which were paediatric cases, treated with techniques including interventional radiography, open thoracotomies and direct extraction through the initial shunt incision. The authors report the youngest case of intracardiac shunt migration complicated by significant coiling and knotting within the cardiac chambers and pulmonary vasculature. Migration likely began when the SVC was pierced during initial shunt placement and progressed due to negative intrathoracic pressure. Extrusion was achieved combining thoracoscopic endoscopy, interventional fluoroscopy screening and a posterolateral neck incision with uncoiling of the shunt via a Seldinger guide wire. This offered a minimally invasive solution with rapid post-operative recovery.
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Affiliation(s)
- Ella Hobbs
- School of Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Dominic N P Thompson
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Adikarige Haritha Dulanka Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
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9
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Awwad AR, S H Odeh M, Asad D, Y M H Abu Rmeileh B, M M Dweik A, N M Baraka S, A F Karami M, I M Awad I, W M Jobran A. Ventriculoperitoneal Shunt Migration Into the Transverse Colon: A Case Report. Cureus 2024; 16:e52334. [PMID: 38361682 PMCID: PMC10867295 DOI: 10.7759/cureus.52334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
A ventriculoperitoneal (VP) shunt is a connection between the cerebral ventricles and the peritoneal cavity. One of the rare complications of this procedure is shunt migration and perforation of the bowel. Our case report presents the case of a 19-month-old male patient who underwent VP shunt insertion due to hydrocephalus at the age of 8 months. He suffered from two episodes of bacterial meningitis at the ages of 11 and 15 months, requiring hospital admission. The patient's parents brought him to the emergency department after noticing a blood-stained diaper and seeing a part of the shunt extruding from the anal opening. Upon physical examination, the patient was active, neither in distress nor tachycardic. with unremarkable abdominal examination and negative peritoneal signs. A digital rectal examination showed normal anal tone, with normal-coloured stool with no blood at the tip of the finger, together with a compressible VP shunt. Complications of this type of migration include faecal contamination and possible infections such as ascending meningitis. This case report highlights the extrusion of the shunt through the anal orifice in a 19-month-old male patient which serves as an example of the uncommon but serious consequence of VP shunt insertion in the pediatric population. While VP shunt insertion remains a widely used and effective treatment for hydrocephalus, healthcare providers need to recognize and address potential complications associated with this procedure. Additionally, this case emphasizes the importance of diligent monitoring and regular radiographic imaging to confirm the correct positioning of shunt components, particularly in the paediatric population.
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Affiliation(s)
- Ahmad R Awwad
- General Practice, Rafidia Governmental Hospital, Nablus, PSE
| | - Manar S H Odeh
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Diya Asad
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | | | - Aya M M Dweik
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Saja N M Baraka
- Medicine, Faculty of Medicine, Al Quds-University, Jerusalem, PSE
| | - Malek A F Karami
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Iyas I M Awad
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Afnan W M Jobran
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
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10
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Stanishevskiy AV, Legzdain MA, Saburov NR, Svistov DV, Gavrilov GV. [Intracardiac migration of a ventriculoperitoneal shunt. A systematic literature review and case report]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:88-96. [PMID: 39670784 DOI: 10.17116/neiro20248806188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
CSF shunting procedures are common in neurosurgery. A rare complication of these procedures is migration of distal catheter. We present a case of peritoneal catheter migration into the right heart chambers. A systematic review of appropriate literature data was carried out. MATERIAL AND METHODS We present a patient with communicating hydrocephalus after previous penetrating traumatic brain injury. Migration of peritoneal catheter into the right heart chambers occurred in 5 days after ventriculoperitoneal shunting. We performed a systematic review of literature data and analyzed all similar cases of intracardiac migration of ventriculoperitoneal catheter, risk factors of migration, possible complications and surgical treatments. RESULTS There were 38 articles describing 40 cases of distal catheter migration into the right heart chambers meeting the inclusion criteria. In 65% of patients, catheter migration was diagnosed after ≥2 months. Migration was asymptomatic in 21% of cases. Additionally, less than 50% of patients had no complications. Surgical treatment required complex techniques such as endovascular removal or thoracotomy in nearly 50% of cases. CONCLUSION Migration of ventriculoperitoneal catheter into the right heart chambers is a rare and dangerous complication of CSF shunting procedures. Risk factors of this complication should be considered when scheduling surgical treatment and follow-up examinations.
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Affiliation(s)
| | - M A Legzdain
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - N R Saburov
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - D V Svistov
- Kirov Military Medical Academy, Saint Petersburg, Russia
| | - G V Gavrilov
- Kirov Military Medical Academy, Saint Petersburg, Russia
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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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12
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Li Z, Zhang H, Hu G, Zhang G. Post-traumatic hydrocephalus: An overview of classification, diagnosis, treatment, and post-treatment imaging evaluation. Brain Res Bull 2023; 205:110824. [PMID: 37995869 DOI: 10.1016/j.brainresbull.2023.110824] [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: 06/18/2023] [Revised: 11/02/2023] [Accepted: 11/20/2023] [Indexed: 11/25/2023]
Abstract
The syndrome of post-traumatic hydrocephalus (PTH) has been recognized since Dandy's report in 1914. The pathogenesis of PTH has not been fully clarified. At present, it is believed that the obstacles of cerebrospinal fluid (CSF) secretion, absorption and circulation pathways are the reasons for the development of PTH. However, recent studies have also suggested that the osmotic pressure load of CSF and the pathological changes of CSF dynamics are caused by the development of hydrocephalus. Therefore, a better understanding of the definition, classification, diagnostic criteria, treatment, and evaluation of post-treatment effects of PTH is critical for the effective prevention and treatment of PTH. In this paper, we reviewed the classification and diagnosis of PTH and focused on the treatment and the imaging evaluation of post-treatment effects of PTH. This review might provide a judgment criterion for diagnosis of PTH and a basis for the effective prevention and treatment of PTH in the future.
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Affiliation(s)
- Zhao Li
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Han Zhang
- Department of Neurosurgery, Shengzhou People's Hospital, Shengzhou City, Zhejiang Province 312400, China
| | - Guojie Hu
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China
| | - Guohai Zhang
- Department of Neurosurgery, Shengzhou Hospital of Traditional Chinese Medicine, Shengzhou City, Zhejiang Province 312400, China.
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Amien B, Harky A, Hill A, Shackcloth M, Asante-Siaw J. A Rare Case of Extraction of Ventriculoperitoneal Shunt From the Left Main Bronchus. Cureus 2023; 15:e51021. [PMID: 38149066 PMCID: PMC10750442 DOI: 10.7759/cureus.51021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2023] [Indexed: 12/28/2023] Open
Abstract
We present the case of a 40-year-old female who underwent several insertions of ventriculoperitoneal (VP) shunts as a part of the treatment for idiopathic intracranial hypertension (IIH). Several years after the insertion of the last VP shunt, the patient started experiencing shortness of breath (SOB) and cough; after further assessment, it was noted on computed tomography (CT) scan that the VP shunt had migrated into the right lower lobe of the lung and perforated the distal left main bronchus. The shunt was successfully retrieved using bronchoscopy under general anesthesia, after which the patient had a complete resolution of symptoms. Shunt migration is one of the rare complications that can happen years after shunt insertion. Therefore, we present this rare case of shunt migration into the thorax cavity to highlight the presentation of this complication and its successful management.
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Affiliation(s)
- Bothayna Amien
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Amer Harky
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Amy Hill
- Anaesthesia and Critical Care, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Michael Shackcloth
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
| | - Julius Asante-Siaw
- Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, GBR
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14
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AlJoaid RM, Alshakhori HH, Haji A, Alfaraj D, Alabbad MF. Closed-Loop Bowel Obstruction Induced by Ventriculoperitoneal Shunt Catheter Coiling at the Sigmoid Colon: A Case Report. Cureus 2023; 15:e49045. [PMID: 38116348 PMCID: PMC10729777 DOI: 10.7759/cureus.49045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/21/2023] Open
Abstract
Intestinal obstruction is a rarely encountered complication in patients with ventriculoperitoneal (VP) shunt. The most common causes of bowel obstruction in this subset of patients include volvulus, formation of a spontaneous knot, and adhesions. Herein, we report a 21-year-old bedridden male with a history of congenital hydrocephalus on VP shunt, spina bifida, neurogenic bladder, and paraplegia who presented with a seven-day history of abdominal discomfort, distention, constipation, vomiting, and intolerance to oral intake. Abdominal x-ray showed dilated bowel loops. Computed tomography (CT) of the abdomen demonstrated a closed-loop bowel obstruction at the level of the sigmoid colon caused by the coiling of the VP shunt catheter. Diagnostic laparoscopy revealed the VP shunt tube coiling around a segment of the sigmoid colon with no signs of bands, ischemia, or perforation. Pulling and shortening of the tube was done. The procedure went uneventfully, and the patient was discharged home in stable condition. Maintaining a high index of suspicion for knotting the peritoneal catheter around the bowel is crucial when a patient on a VP shunt presents with a picture suggestive of intestinal obstruction. Early surgical intervention might be required to prevent further progression and complications.
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Affiliation(s)
- Rinad M AlJoaid
- Emergency Department, Imam Abdulrahman bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Hawra H Alshakhori
- Emergency Department, Imam Abdulrahman bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Arwaa Haji
- Emergency Department, Imam Abdulrahman bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Dunya Alfaraj
- Emergency Department, Imam Abdulrahman bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Murad F Alabbad
- Emergency Department, Imam Abdulrahman bin Faisal University, King Fahd University Hospital, Dammam, SAU
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15
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Chen YC, Chen PY, Yang PJ. Man with an Abdominal Mass. Ann Emerg Med 2023; 82:e159-e160. [PMID: 37739758 DOI: 10.1016/j.annemergmed.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Yen-Chung Chen
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Po-Yuan Chen
- Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Po-Jen Yang
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
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16
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Basehi A, Al-Saleh AM, Almoffarreh H, Alkarawi S, Alharbi M. A Ventriculoperitoneal Shunt With Anal Protrusion Causing Meningitis in A Child. Cureus 2023; 15:e45857. [PMID: 37881402 PMCID: PMC10594395 DOI: 10.7759/cureus.45857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Abstract
The ventriculoperitoneal (VP) shunt has been one of the primary methods for treating hydrocephalus for many years and is one of the most frequent surgical interventions performed in neurosurgery using a variety of techniques and different VP shunt types. Consequently, shunt insertion is associated with many complications, including insertion failure, functional failure, and mechanical failure such as shunt migration. Shunt migration to the gastrointestinal or urogenital tract is a rare and one of the most distressing complications, which can lead to ascending infection and even meningitis. We report a rare case of a 24-month-old male with a VP shunt tube that migrated and protruded from the anus, subsequently causing meningitis.
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Affiliation(s)
- Ahmed Basehi
- Pediatric Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, SAU
- Pediatric Emergency Medicine Department, King Abdullah International Medical Research Center, Riyadh, SAU
- Pediatric Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Abdullah M Al-Saleh
- Pediatric Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, SAU
- Pediatric Emergency Medicine Department, King Abdullah International Medical Research Center, Riyadh, SAU
- Pediatric Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Haitham Almoffarreh
- Pediatric Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, SAU
- Pediatric Emergency Medicine Department, King Abdullah International Medical Research Center, Riyadh, SAU
- Pediatric Emergency Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sarmad Alkarawi
- Pediatric Neurosurgery Department, Ministry of the National Guard - Health Affairs, Riyadh, SAU
- Pediatric Neurosurgery Department, King Abdullah International Medical Research Center, Riyadh, SAU
- Pediatric Neurosurgery Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohammed Alharbi
- Pediatric Medicine Department, Maternal and Children Hospital, Qassim, SAU
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17
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Lee CB, Park J. Distal Ventriculoperitoneal Shunt Catheter Migration into the Pulmonary Vasculature and Cardiac Chamber: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:934-940. [PMID: 37559803 PMCID: PMC10407080 DOI: 10.3348/jksr.2022.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/20/2022] [Accepted: 11/13/2022] [Indexed: 08/11/2023]
Abstract
Ventriculoperitoneal shunting is the most common neurosurgical procedure for treatment of hydrocephalus. Shunt-related complications are relatively common and associated with a high rate of shunt revision. However, migration of the distal ventriculoperitoneal shunt, especially into the cardiac and intravascular regions, has rarely been reported. Awareness of this rare but potentially hazardous complication is important owing to its significant morbidity, which can be prevented by prompt management. Here, we introduce a case of a 23-year-old male with migration of the distal shunt catheter through the left internal jugular vein into the cardiac chamber and both pulmonary arteries, which occurred 2 months after receiving ventriculoperitoneal shunting. Furthermore, we discuss the possible mechanisms and management of this condition.
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18
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Topp G, Entezami P, Ambati S, Szewczyk B, Adamo MA. Cerebrospinal Fluid Leakage from Scrotum Secondary to Ventriculoperitoneal Shunt Migration. Asian J Neurosurg 2023; 18:333-335. [PMID: 37397057 PMCID: PMC10310443 DOI: 10.1055/s-0043-1763521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Ventriculoperitoneal (VP) shunts are a common neurosurgical procedure used to treat hydrocephalus. Despite their efficacy, many shunts fail and require revisions. The most common causes of shunt failure include obstruction, infection, migration, and perforation. Extraperitoneal migrations require urgent attention. We present a case of migration to the scrotum, a unique complication that may be present in young patients due to the presence of a patent processus vaginalis. Here, we discuss a case of a 16-month-old male patient with a VP shunt presenting with cerebrospinal fluid (CSF) drainage from his scrotum after an indirect hernia repair. This case represents an important reminder for physicians about the sequelae associated with VP shunt complications, particularly extraperitoneal migration, and brings awareness to the underlying factors that may increase this risk.
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Affiliation(s)
- Gregory Topp
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Shashikanth Ambati
- Department of Paediatrics, Albany Medical Center, Albany, New York, United States
| | - Benjamin Szewczyk
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Matthew A. Adamo
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
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19
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Chanchlani R, Sharma PK, Gunasekaran V, Kasundra A. Scrotal migration of peritoneal end of ventriculoperitoneal shunt in an infant - A rare entity. J Neurosci Rural Pract 2023; 14:365-367. [PMID: 37181190 PMCID: PMC10174175 DOI: 10.25259/jnrp_76_2022] [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: 12/20/2022] [Accepted: 02/18/2023] [Indexed: 03/30/2023] Open
Abstract
Ventriculoperitoneal shunt migration into the scrotum is a rare phenomenon that has been reported in nearly 35 patients in the literature till date. Genitalia-related complications of ventriculoperitoneal shunts in children like inguinoscrotal migration usually occur during 1st year of the shunt procedure due to factors like raised abdominal pressure and patency of process vaginalis. We report a case of scrotal migration of tip of ventriculoperitoneal shunt in a 2-month-old infant presenting to us with communicating hydrocephalus. In a patient with inguinoscrotal swelling and ventriculoperitoneal shunt, migration of shunt should be suspected. Prompt diagnosis and management of this condition is important due to various complications like shunt dysfunction and testicular lesions. Treatment of this condition is surgical closure of the patent processes vaginalis and shunt reposition.
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Affiliation(s)
- Roshan Chanchlani
- Department of Pediatric Surgery, AIIMS, Bhopal, Madhya Pradesh, India
| | | | | | - Ankit Kasundra
- Department of Pediatric Surgery, AIIMS, Bhopal, Madhya Pradesh, India
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20
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Scarascia A, Atallah E, Pineda MDA, Rosenwasser R, Judy K. Gastric perforation from a migrating ventriculoperitoneal shunt: A case report and review of literature. Radiol Case Rep 2022; 17:4899-4902. [PMID: 36281285 PMCID: PMC9587122 DOI: 10.1016/j.radcr.2022.09.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/01/2022] Open
Abstract
Ventriculoperitoneal (VP) shunts represent a surgical option for patients affected by increased intracranial hypertension when medical management fails or is contraindicated. Complications following implantation include shunt obstruction, infection, over and under drainage, migration or disconnection of the tube, formation of a pseudocyst, and allergy to the silicone tube. We report the case of a 31-year-old woman who presented to the emergency room with nausea and generalized malaise, found to have the distal segment of the VP catheter perforating her gastric wall into the stomach lumen which required surgical intervention. In this report, we describe a rare complication associated with the implantation of ventriculoperitoneal shunt (VPS) catheters and the subsequent management plan.
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Affiliation(s)
- Alessio Scarascia
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome RM, Italy,Corresponding author.
| | - Elias Atallah
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
| | | | - Robert Rosenwasser
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
| | - Kevin Judy
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
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21
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Ambati SR, Barry S, Matthew AA, Edwards M. Transvaginal Migration of Ventriculoperitoneal Shunts in Children: Review of Literature. Asian J Neurosurg 2022; 17:399-406. [PMID: 36398177 PMCID: PMC9665996 DOI: 10.1055/s-0042-1757218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ventriculo-peritoneal shunt placement is the most commonly performed procedure for the treatment of hydrocephalus. The complication of migration of the distal ventriculo-peritoneal shunt is one of the many complications that occur after ventriculo-peritoneal shunt placement. The migration of the ventriculo-peritoneal shunt through the vagina is infrequently reported in children. The aim of this review is to help all the providers caring for children with ventriculo-peritoneal shunts to identify issues early when encountered with this complication and thus limit morbidity and mortality. We reviewed all cases of migration of ventriculo-peritoneal shunt through the vagina in children less than 18 years of age that were published in the literature using PubMed, Google Scholar, Web of Science, and Cochrane Library. A total of 11 articles met the eligibility criteria and were included in this review among the 93 articles obtained with title and abstract screening. Previous non-shunt-related abdominal operations and shunt revisions are consistent risk factors in all cases. We did not recognize specific approaches to catheter placement or management that could have prevented this complication. Ventriculitis necessitating shunt removal and therapies requiring additional procedures and prolonged hospitalization are the major consequences identified. Awareness of this unusual complication is very important among health care providers such as emergency care health providers who are likely to be the first to encounter these children on initial presentation.
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Affiliation(s)
- Shashikanth R Ambati
- Department of Pediatric Critical Care, Albany Medical Center, Albany, New York, United States,Address for correspondence Shashikanth Ambati, MBBS Pediatric Critical Care, Albany Medical Center43 New Scotland Ave, A422, Albany, NY 12208United States
| | - Suzanne Barry
- Department of Pediatric Critical Care, Albany Medical Center, Albany, New York, United States
| | - Adamo A Matthew
- Department of Pediatric Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Mary Edwards
- Department of Pediatric Surgery, Albany Medical Center, Albany, New York, United States
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22
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Alkhudari A, Galal M, Wagley Z, Sabbah BN, Houdane A, Aljabr A. A case of spontaneous resolution of a scrotal ventriculoperitoneal shunt migration. Radiol Case Rep 2022; 17:3620-3623. [PMID: 35923335 PMCID: PMC9340143 DOI: 10.1016/j.radcr.2022.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/02/2022] Open
Abstract
Ventriculoperitoneal (VP) shunt catheter migration remains a rare but documented complication seen in one in 1000 patients who receive a VP shunt. Migration of the VP shunt into the scrotum is even more uncommon and requires surgical treatment. We report a unique case of a 6-month-old preterm male who developed right scrotal migration of his VP shunt. However, the tip of the VP shunt spontaneously reduced to its normal position, and repeated imaging months later showed no recurrence.
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Affiliation(s)
- Anas Alkhudari
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Maad Galal
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Zainab Wagley
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Belal Nedal Sabbah
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Abdelrafour Houdane
- College of Medicine, Alfaisal University, Al Takhassousi, Al Zahrawi Street, Riyadh 11533, Kingdom of Saudi Arabia
| | - Aljohara Aljabr
- Department of Radiology, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
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23
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Yang X, Yang C, Zhang Y. Case report: Ventriculoperitoneal shunt disconnection resulting in migration of the distal catheter entirely into the abdominal cavity due to seizure. Front Surg 2022; 9:1012720. [PMID: 36211301 PMCID: PMC9537736 DOI: 10.3389/fsurg.2022.1012720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
Ventriculoperitoneal (VP) shunt disconnection, a VP shunt complication, can be caused by several factors. We report the case of a young man who suffered VP shunt disconnection, and whose entire distal catheter migrated into the abdominal cavity due to a seizure. To our knowledge, risk factors for seizures related to shunt disconnection have not been previously evaluated. We report this rare case to highlight the fact that seizures are not negligible in increasing the probability of disconnection and migration of the entire distal catheter into the abdominal cavity, and the standardized treatment of traumatic seizures is extremely important.
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24
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Walker RW, Roman GC, Zhang YJ, Acres O. Pleural effusion and respiratory compromise from spontaneous migration of a ventriculoperitoneal shunt catheter in a patient with normal-pressure hydrocephalus. Surg Neurol Int 2022; 13:393. [PMID: 36128165 PMCID: PMC9479560 DOI: 10.25259/sni_486_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Ventriculoperitoneal shunt (VPS) insertion is one of the most common neurosurgical procedures done around the world to treat hydrocephalus. The occurrence of spontaneous migration of the peritoneal shunt catheter into the thoracic cavity is a very rare complication; we report here case number 27 of respiratory complications of a VPS in a patient with normal-pressure hydrocephalus (NPH). Case Description: A 76-year-old woman with Alzheimer’s disease and anosognosia was diagnosed idiopathic NPH treated surgically with a VPS. Pleural effusion and pulmonary complications occurred 4 weeks after the insertion of the shunt due to the spontaneous migration of the peritoneal catheter of the VPS into the thoracic cavity. The hydrothorax of cerebrospinal fluid was drained and the distal catheter was removed and replaced. The patient made an uneventful recovery. Conclusion: Due to the rarity of this complication, there are no standard corrective procedures. Some of the methods used to diagnose and successfully treat this rare complication of the VPS are presented.
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Affiliation(s)
| | | | | | - Omar Acres
- Department of Hospitality, Houston Methodist Clear Lake Hospital, Nassau Bay, Texas, United States
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25
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Alanazi RF, Saeed M, Azzubi MA. Parieto-Occipital Shunt Migration in a Patient with Congenital Hydrocephalus and Dandy-Walker syndrome: Case report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101508] [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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26
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Gupta A, Murali A, Kumar R, Maurya DK, Keepanasseril A. Migration of Ventriculoperitoneal Shunt to the Uterus in a Child: A Case Report. J Pediatr Adolesc Gynecol 2022; 35:196-198. [PMID: 34843976 DOI: 10.1016/j.jpag.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A ventriculoperitoneal shunt (VPS) is usually placed inside the peritoneal cavity for cerebrospinal fluid drainage. Rarely, it can migrate to various pelvic visceral organs. Inside the pelvis, the distal end of the shunt can perforate anywhere from the uterus or adnexa to the vulva, and migration through the uterus is extremely rare. CASE A three-and-a-half-year-old girl presented with a cerebrospinal fluid leak through the vagina after uterine perforation by a VPS. The diagnosis was made with an ultrasound. Her symptoms resolved after revision surgery. CONCLUSION In a patient with a VPS in situ, presenting with a watery fluid leak through the vagina, perforation of the fornix or uterus must always be kept in mind. Timely diagnosis and intervention can result in the prevention of complications.
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Affiliation(s)
- Avantika Gupta
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India.
| | - Akshaya Murali
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Rajinder Kumar
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Dilip Kumar Maurya
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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27
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Ghaffari S, Hashemzadeh K, Samadi M, Molaei A, Sadeghi S, Jamei Khosroshahi A. Upward spontaneous migration of ventriculoperitoneal shunt into the heart: A case report summary. J Cardiovasc Thorac Res 2022; 14:263-267. [PMID: 36699559 PMCID: PMC9871159 DOI: 10.34172/jcvtr.2022.30523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 12/17/2022] [Indexed: 01/09/2023] Open
Abstract
A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered.
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Affiliation(s)
- Shamsi Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Pediatric Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Khosro Hashemzadeh
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahmood Samadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Pediatric Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Akbar Molaei
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Pediatric Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Sadeghi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Pediatric Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Jamei Khosroshahi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Pediatric Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding Author: Ahmad Jamei Khosroshahi,
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28
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Rigueiral MEG, Cobucci FLR, de Aguiar PHSP, Vieira RVG, Pacheco CC, Medeiros RTR, de Aguiar PHP. Rare complication of ventriculoperitoneal shunt: Ectopic distal catheter in a Grynfeltt hernia - case report. Surg Neurol Int 2021; 12:525. [PMID: 34754575 PMCID: PMC8571190 DOI: 10.25259/sni_330_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background Ventriculoperitoneal shunts (VPSs) insertion is the most common used intervention in cases of hydrocephalus. The main postoperative complications are infections and catheter obstructions. Although the literature has well-documented cases describing migration of the distal catheter, this rare presentation can become more confusing when occurring in conjunction with some unusual preexistent morbidity in the patient, as a Grynfeltt hernia. Case Description This study reports a rare case of a VPS postoperative migration, in which the distal catheter exits the abdominal cavity through a Grynfeltt hernia. This condition was not discovered until the catheter fistulated through the overlying skin. The Grynfeltt hernia is the most uncommon among the lumbar ones and it's asymptomatic in the majority of the cases, being hardly diagnosed. Conclusion The unusualness of the reported case deserves furthermore discussion to properly evaluate these underlying mechanisms of catheter migration.
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Affiliation(s)
| | | | | | | | | | | | - Paulo Henrique Pires de Aguiar
- Department of Molecular Biology, ABC Medical School, Santo André, Brazil.,Department of Neurosurgery, Santa Paula Hospital, Sorocaba, Brazil.,Department of Neurology of Pontifical Catholic University of Sao Paulo, Sorocaba, Brazil
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29
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Alghamdi K, Kutub LH, Qasem AG, Kaneetah AH, Alzahrani SG, Kutub HY. Upward Migration and Coiling of the Distal Catheter Toward the Valve Site. Cureus 2021; 13:e17993. [PMID: 34667670 PMCID: PMC8519186 DOI: 10.7759/cureus.17993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/11/2022] Open
Abstract
Hydrocephalus, which is caused by the accumulation of cerebrospinal fluid (CSF), is a common condition in children. It is known to be most likely treated by the insertion of a ventriculoperitoneal (VP) shunt. However, a VP shunt can lead to multiple complications. The upward migration of a VP shunt is considered rare. A newborn male baby with a known case of Chiari malformation type 2 associated with myelomeningocele (MMC) and hydrocephalus had a VP shunt inserted for control of the hydrocephalus. He presented two months after the surgery with occipital swelling at the surgical site. Shunt series followed by Computerized tomography (CT) scan showed that the distal end of the catheter had migrated upward and coiled around the valve. Urgent revision of the VP shunt was performed. Reabsorption of subgaleal fluid, increased abdominal pressure, repeated abdominal wall contraction, and repeated head motion of the child are the previously suggested theories of upward migration of distal catheter to the site of the valve. However, the combination of multiple theories can be the logical explanation, as they do not oppose each other.
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Affiliation(s)
- Khalid Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Luma H Kutub
- College of Medicine, Batargi Medical College, Jeddah, SAU
| | | | - Abdulrahman H Kaneetah
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah , SAU
| | - Sultan G Alzahrani
- College of medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Centre, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, SAU
| | - Hussam Y Kutub
- Neurosurgery, King Abdulaziz Medical City, Ministry of National Guards Health Affairs, Jeddah, SAU
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30
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Lampros M, Alexiou GA, Voulgaris S. Commentary: Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases. Oper Neurosurg (Hagerstown) 2021; 21:E393-E394. [PMID: 34245155 DOI: 10.1093/ons/opab256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marios Lampros
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - George A Alexiou
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
| | - Spyridon Voulgaris
- Department of Neurosurgery, University Hospital of Ioannina, Ioannina, Greece
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31
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Lodhia J, Rashid SM, Msemo A, Philemon R, Sadiq A, Chilonga K, Msuya D. Bilateral Subdural Hematoma following Ventriculoperitoneal Shunt Insertion in a Ten-month Old Tanzanian Female with Congenital Hydrocephalus: An Uncommon Presentation. East Afr Health Res J 2021; 5:17-19. [PMID: 34308240 PMCID: PMC8291209 DOI: 10.24248/eahrj.v5i1.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
There is an unmet need for the treatment of hydrocephalus in Tanzania. Thousands of newborns each year in the region are affected by this condition and access to care remains a challenge. While treatment options like cerebrospinal fluid diversion through ventriculo-peritoneal shunting are within the skill set of general surgeons, the potential complications represent an additional challenge. We present a 10-month-old Tanzanian female who developed bilateral-subdural hematomas after insertion of a ventriculoperitoneal shunt.
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Affiliation(s)
- Jay Lodhia
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi-Tanzania
| | | | - Abdallah Msemo
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi-Tanzania
| | - Rune Philemon
- Kilimanjaro Christian Medical University College, Moshi-Tanzania.,Department of Pediatrics and Child Health, Kilimanjaro Christian Medical Center, Moshi-Tanzania
| | - Adnan Sadiq
- Kilimanjaro Christian Medical University College, Moshi-Tanzania.,Department of Radiology, Kilimanjaro Christian Medical Center, Moshi-Tanzania
| | - Kondo Chilonga
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi-Tanzania.,Kilimanjaro Christian Medical University College, Moshi-Tanzania
| | - David Msuya
- Department of General Surgery, Kilimanjaro Christian Medical Center, Moshi-Tanzania.,Kilimanjaro Christian Medical University College, Moshi-Tanzania
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32
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Nielsen JK, Miscov R, Birkeland PF. Unusual Cause of Unilateral Breast Swelling. World Neurosurg 2021; 152:3-4. [PMID: 34087461 DOI: 10.1016/j.wneu.2021.05.111] [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: 04/09/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
A 69-year-old woman with bilateral breast implants and a newly inserted ventriculoperitoneal shunt presented with a 4-day history of swelling of the right breast. There were no signs of infection and blood tests were normal. With the help of ultrasound, mammogram, and computed tomography, the distal catheter of the shunt was found to be surrounding the right breast implant. During surgery the catheter was tunneled away from the breast and reinserted into the peritoneal cavity. She was discharged the next day. Ventriculoperitoneal shunt migration to the breast is a rare complication that can lead to cerebrospinal fluid accumulation and may be avoided by carefully tunneling away from the implant.
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Affiliation(s)
| | - Rares Miscov
- Department of Neurosurgery, Aalborg University Hospital, Aalborg, Denmark
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33
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Alhendawy I, Dhaliwal T, Siedler DG, Homapour B. Early postoperative colonic ventriculoperitoneal shunt migration with trans-anal protrusion: A unique case report. Int J Surg Case Rep 2021; 81:105796. [PMID: 33770638 PMCID: PMC7994786 DOI: 10.1016/j.ijscr.2021.105796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/17/2023] Open
Abstract
Early post-operative trans-anal shunt protrusion is a rare presentation. Patients may be asymptomatic. With concomitant bowel surgery, it may indicate intraoperative occult bowel injury. Early post-operative follow up shunt imaging is recommended in this group. Introduction and importance Colonic ventriculoperitoneal shunt (VPS) migration with trans-anal protrusion remains uncommon. Patients may be asymptomatic, and diagnosis may only be made on visualization of the prolapsed catheter from the anus. This unique case of early post-operative trans-anal shunt protrusion highlight the possibility of this rare complication specially when shunt revision accompanies bowel surgery. Case presentation The authors present a case of early postoperative colonic shunt migration in a thirteen-year-old female with who underwent Malone Antegrade Continence Enema (MACE) with concomitant revision of the distal part of the peritoneal catheter. She presented two weeks post operatively with shunt catheter protruding from the anus. This was noticed by her carer and she was asymptomatic on her presentation. Clinical discussion Delayed post-operative shunt related bowel perforation and trans-anal shunt protrusion is an uncommon complication after ventriculoperitoneal shunting. Most cases present months after surgery and majority are asymptomatic on presentation. The exact pathophysiology is not established, and mechanisms have been proposed. Early post -operative trans-anal shunt protrusion is rare and suggests inadvertent occult bowel injury especially when shunt placement or revision accompanies extensive bowel surgery. Conclusion The authors recommended shunt imaging within the first two to three weeks after shunt revision in patient who undergo concomitant bowel surgery with risk of inadvertent bowel injury to identify early colonic migration and avoid its potentially fatal sequelae.
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Affiliation(s)
- Ibrahem Alhendawy
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
| | - Tarundeep Dhaliwal
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
| | - Declan G Siedler
- Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, 3004, Australia.
| | - Bob Homapour
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
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Hidayat I, Syahputra DA, Isa MM. Unusual migration of distal ventriculoperitoneal shunt to Vagina via fallopian tube: A case report. Ann Med Surg (Lond) 2021; 63:102158. [PMID: 33659058 PMCID: PMC7890132 DOI: 10.1016/j.amsu.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction and Importance: Ventriculoperitoneal shunt (VPS) is the most common procedure performed on children with hydrocephalus. Migration of VPS outside the peritoneal cavity is rare, especially fallopian tube migration with vaginal extrusion without organ perforation. Presentation of Case: A 3-year-old girl came to the hospital with the main complaint of having a white tube exposed from her vagina 4 days before admission. A history of frequent clear watery discharge from the vagina since one week before the admission alongside intermittent pain in the suprapubic area was obtained from the parents. A laparotomy was conducted on the patient. We found the distal shunt catheter had adhered to the omentum and it appeared that the catheter tube entered the right fallopian tube before it went into the uterus and out to the vagina. We replaced the distal catheter with a new one. The patient came home on the fourth day of the post-surgery in a good condition. Clinical Discussion: The etiology of distal shunt catheter migration into the vagina remains unclear. Our patient is the third documented case of fallopian tube migration with vaginal extrusion without organ perforation, suspected due to postsurgical adhesions to the fallopian tube. An evaluation of vaginal discharge associated with abdominal pain is an important clue for distal migration of the VPS to the vagina. Conclusion: The migration of catheter to the vagina should be considered of profuse watery discharge from vagina alongside intermittent abdominal colicky pain. The surgical goal is to re-establish a new VP shunt system.
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Affiliation(s)
- Imam Hidayat
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
| | - Dian Adi Syahputra
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
| | - Muntadhar Muhammad Isa
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
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Truffelli M, Ceraudo M, Cavelli M, Prior A, Balestrino A, Fiaschi P. Letter to the Editor Regarding "Diagnosis of Ventriculoperitoneal Shunt Malfunction: A Practical Algorithm". World Neurosurg 2020; 140:455. [PMID: 32797972 DOI: 10.1016/j.wneu.2020.05.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Monica Truffelli
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Marco Ceraudo
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Marcella Cavelli
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
| | - Alessandro Prior
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Alberto Balestrino
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Pietro Fiaschi
- Department of Neurosurgery, Policlinico San Martino Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Children's Sciences, University of Genoa, Genoa, Italy
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36
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Bertozzi M, Fusi G, Chiodi M, Di Cara G. An Unexpected Case of Life-Threatening Hydrothorax in a Child. J Emerg Med 2020; 59:e31-e32. [PMID: 32451183 DOI: 10.1016/j.jemermed.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Mirko Bertozzi
- Pediatric Surgery Unit, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Giulia Fusi
- Pediatric Surgery Unit, University of Siena, Siena, Italy
| | - Marino Chiodi
- Radiology Unit, S. Maria Della Misericordia Hospital, Perugia, Italy
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37
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Chen YH, Hsieh CT, Sun JM, Chang SI. Gastric perforation by a ventriculoperitoneal shunt in an adult. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2020; 25:144-147. [PMID: 32351252 PMCID: PMC8015529 DOI: 10.17712/nsj.2020.2.20190118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ventriculoperitoneal (VP) shunt operation is a common neurosurgical procedure applied for managing intracranial hydrocephalus. Migration of a distal catheter is an uncommon complication, and related gastric perforation is rarely reported. Herein, we report the case of gastric perforation in a patient with VP shunt who presented with fever. The distal catheter within the stomach was confirmed by preoperative computed tomographic scan of abdomen and gastric endoscopy. Surgical intervention and appropriate antibiotics management enabled patient recovery. This case emphasizes the importance of early recognition and surgical intervention in this rare complication related to the shunt procedure. Received 9th December 2019. Accepted 23th January 2020.
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Affiliation(s)
- Yu-Hao Chen
- Section of Neurosurgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
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38
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de Oliveira AJM, Rossi J, Morales MNB, Reis BM, Pinto FCG. An unusual ventriculoperitoneal shunt complication: catheter migration into the breast. AUTOPSY AND CASE REPORTS 2020; 10:e2020165. [PMID: 33344283 PMCID: PMC7703404 DOI: 10.4322/acr.2020.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Adilson José Manuel de Oliveira
- Universidade de São Paulo (USP), Faculty of Medicine, Neurosurgery Department. São Paulo, SP, Brazil.,Clinica Girassol, Neurosurgery Service. Luanda, Angola
| | - Jefferson Rossi
- Universidade de São Paulo (USP), Faculty of Medicine, Neurosurgery Department. São Paulo, SP, Brazil
| | | | - Bruno Monteiro Reis
- Universidade de São Paulo (USP), Faculty of Medicine, Neurosurgery Department. São Paulo, SP, Brazil
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39
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Inguinal Extrusion of a Ventriculoperitoneal Shunt. World Neurosurg 2020; 138:242-245. [PMID: 32179187 DOI: 10.1016/j.wneu.2020.03.041] [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: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Complications of ventriculoperitoneal (VP) shunts include migration into various anatomic compartments and even extrusion through tissue layers. CASE DESCRIPTION A 31-year-old female patient with a VP shunt presented with distal shunt tubing extruding through the skin at the level of the inguinal ligament. Shunt hardware was removed, and cultures grew Dermacoccus. The patient was treated with broad-spectrum antibiotics and underwent placement of a lumboperitoneal shunt. CONCLUSIONS Dermacoccus is a gram-positive skin organism with rare human pathogenicity and not previously known to cause shunt infections.
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40
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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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