Coiling and migration of peritoneal catheter into the breast: a very rare complication of ventriculoperitoneal shunt

Upward migration of distal catheter of a ventriculoperitoneal shunt with coiling is very rare. Pseudocyst and galactorrhea are known breast-related complications. Here, we report a 13-year-old girl, known case of myelomeningocele and shunted hydrocephalus, who presented with right breast pseudocyst due to distal tube migration and coiling of the catheter. Plain radiography was not diagnostic because of severe levoscoliosis, but chest computed tomography scan was confirmatory of shunt coiling lateral to the breast. The possible mechanisms causing this uncommon complication are described.     

Protrusion of a peritoneal catheter via abdominal wall and operated myelomeningocele area: a rare complication of ventriculoperitoneal shunt

Background

Ventriculoperitoneal shunting is mostly used in the treatment of hydrocephalus, and many complications have been reported with this method. These complications include obstruction, mechanical shunt failure, infection, and abdominal complications. Abdominal complications include intestinal obstruction, volvulus, peritonitis, peritoneal cyst, cerebrospinal fluid ascites, as well as migration of the distal catheter via the intestinal tract, umbilicus, scrotum, and vagina. Various mechanisms have been suggested with regards to the catheter migration.

Case report

We present a case of a 21-month-old female patient who had myelomeningocele at birth. She underwent repair of the myelomeningocele at the age of 10 days. After 4 months, cranial computed tomography revealed hydrocephalus, and ventriculoperitoneal shunt was placed. Because of shunt dysfunction, a new ventriculoperitoneal shunt system was installed at the age of 12 months. Eight months later, her mother noticed the protrusion of peritoneal catheter via abdominal wall and repaired myelomeningocele area. Revision of the lower end of the shunt was done, and myelomeningocele area was repaired again.

Conclusion

We report a unique patient with the protrusion of the distal catheter through repaired myelomeningocele area and abdominal wall in the lumbar region.     

CSF hydrothorax – VP shunt complication without displacement of a peritoneal catheter

Cerebrospinal fluid hydrothorax is reported as a rare complication of ventriculoperitoneal (VP) shunt. A 16-month-old boy known to have congenital hydrocephalus and a Dandy-Walker cyst presented with serious respiratory distress. Examination revealed right pleural effusion and congested throat. Thoracocentesis with drainage of the pleural cavity for 10 days failed to free the patient from pleural effusion. Following an intraperitoneal injection of Omnipaque a chest X-ray was done, and samples of pleural fluid taken before and after the injection were compared on X-ray, revealing the presence of contrast in the postinjection pleural effusion. Changing the VP shunt for a ventriculo-atrial shunt resulted in immediate (within 1 day) complete disappearance of the pleural effusion and of the patient's chest symptoms. Probable causes of this rare complication are discussed, and attention is drawn to the possibility of its appearance and early recognition. Intraperitoneal injection of contrast material followed by X-ray examination of fluid in the chest is a simple, safe, and reliable method of diagnosis when it is suspected.     

Spontaneous peritoneal catheter knot formation: A rare cause of ventriculoperitoneal shunt malfunction

Ventriculoperitoneal (VP) shunting remains invaluable in the management of hydrocephalus. It is a common procedure that can be complicated by shunt malfunction due to infection, blockage and disconnection. Spontaneous peritoneal catheter knot formation causing CSF flow obstruction is a rare phenomenon. We present a case of a 12 years old boy with spontaneous knot formation in the peritoneal catheter causing VP shunt obstruction and hydrocephalus.     

CSF ascites: a rare complication of ventriculoperitoneal shunt surgery

CSF ascites is a very rare complication of ventriculoperitoneal (VP) shunt procedure. No definite explanation has been offered for the inability of the peritoneum to absorb the CSF. Two children who underwent VP shunting for hydrocephalus, presented with ascites 3 (1/2) years and 4 months respectively, after the shunt was placed. The treatment of choice is conversion of the VP shunt to a ventriculoatrial shunt.     

Total extrusion of a cranial peritoneal shunt per rectum.

This case report demonstrates an unusual complication of a cranial peritoneal shunt. The shunt perforated the bowel and was extruded per rectum. This caused significant anxiety for the individual but did not cause any serious morbidity.     

Intracerebral hematoma following lumboperitoneal shunt insertion: a rare case report

Lumboperitoneal shunting is widely used for the surgical management of pseudotumor cerebri and other pathologies such as communicating hydrocephalus. Although it is a safe method, it could be associated with complications including subarachnoid hemorrhage, subdural and rarely intracerebral hematoma. A 44-year-old female applied to our clinic with complaints of severe headache, retroorbital pain and blurred vision. Lumbar puncture demonstrated cerebrospinal fluid opening pressure of cmH2O. A non-programmable lumboperitoneal shunt with two distal slit valves was inserted due to pseudotumor cerebri. She deteriorated shortly after surgery. Immediate cranial computed tomography scan revealed a right parietal intracerebral hematoma. Development of intracerebral hematoma following lumboperitoneal shunt is a rare complication. We discuss this rare event accompanied by the literature.     

Unusual complication of peritoneal drainage: migration of a shunt in the subdural space

Quite a number of cases of upward shunt migration have already been reported in the literature. The authors report the case of a newborn boy who presented a sequential alternate change of pressure gradients based, according to their opinion, on fields of pressures exerted by fluids in different compartments of the patient's body. The authors propose a physicoanatomical explanation on the basis of the surgical findings.     

Spontaneous extrusion of migrated ventriculoperitoneal shunt catheter through chest wall: a case report

Ventriculoperitoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. VP shunt related complications remain a persistent problem in clinical practice. However, extrusion of components of shunt apparatus is very rare. Extrusion of ventriculo-peritonea l(VP) shunt catheter is an unusual complication of ventriculoperitoneal shunt Surgery. The authors report a case of a 17-year old female who presented with spontaneous extrusion of VP shunt catheter through the anterior chest wall. Pertinent literature is reviewed regarding the etiology and remedial measures to minimize this unusual complication of a very commonly performed neurosurgical procedure.     

An unusual complication of ventriculoperitoneal shunt with bladder perforation and extrusion through the urethra orifice in an adult male patient

A 29-year-old male exhibited progressive extrusion of the distal end of ventriculoperitoneal (VP) shunt through his urethral orifice within 10 d. The distal end of VP shunt was pulled out from the urethral orifice without bladder repairment, a new VP shunt assisted with ventriculoscope and laparoscope was performed and the distal end of VP shunt was fixd to the suprahepatic space. We first report a chronic complication of VP shunt with bladder perforation and extrusion through the urethral orifice in an adult male patient. To avoid this complication, the length of the distal end of VP shunt should be kept as short as possible in adults and we recommend that the distal end of VP shunt should be fixed to the suprahepatic space assisted with laparoscope in adult patients.     

Spontaneous extrusion of peritoneal catheter through intact abdominal wall

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.     

Device for percutaneous insertion of a distal catheter in ventriculo-atrial shunt. Technical report

Introduction and objectivesA ventriculo-atrial shunt is indicated for the treatment of some hydrocephalus cases. The distal catheter is usually inserted into the right atrium through cervical venous dissection. Percutaneous insertion has been described with success; however its use is not widespread. The aim of this work is to describe modifications in the distal catheter of a ventriculo-atrial shunt, the technique for its percutaneous insertion and the clinical outcome of the process.Material and methodsThe distal catheter was modified after its use in 4 animal specimens. It was designed «over the wire», with its flexibility being reduced and accessories being added. The device was subsequently used in humans, with slight modifications of the jugular vein catheterization technique. We evaluated complications, surgical time and outcome during 6 months.ResultsIn the course of one year, 6 adult patients in whom the peritoneum was no longer receiving cerebrospinal fluid were treated for hydrocephalus. The mean operating time was 34 minutes (including proximal catheter insertion). There were no complications and ventricular size improved.ConclusionsThe percutaneous technique has proved useful: it reduces surgical time and has a very low rate of complications. Apparently, modifications made in the distal catheter caused no complications and avoided the use of other materials designed for other purposes. More cases are required to perform a definitive analysis.     

Hepatic myelopathy: a rare complication following extrahepatic portal vein occlusion and lienorenal shunt

A 19-year-old gentleman presented with slowly progressive spastic paraparesis, 2 years after the therapeutic lienorenal shunt for portal hypertension secondary to cirrhosis and portal vein occlusion. After 2 years of initial evaluation, the motor functions had not worsened further. He did not have any obvious clinical or EEG features of hepatic encephalopathy. Other causes for myelopathy were ruled out. Contribution of portal vein occlusion to portosystemic shunting has not been reported previously in patients with 'hepatic myelopathy.' This uncommon complication needs to be considered in patients with shunt surgery for relieving portal hypertension.     

Subarachnoid hemorrhage and intracereebral hematoma following lumboperitoneal shunt for pseudotumor cerebri: a rare complication

Placement of lumboperitoneal (LP) shunt as a surgical treatment for benign intracranial hypertension (BIH) is generally a safe procedure, with complications like mechanical failure, overdrainage and infections. Subarachnoid hemorrhage and intracerebral hematoma were seen after lumboperitoneal shunt in a patient having BIH. These complications were the cause of the patient's deterioration. After removal of the hematoma and performing a decompressive procedure, patient's neurological condition improved. The clinical features, investigations and clinical course are described and the literature reviewed.     

Treatment approaches for abdominal migration of peritoneal catheter of ventriculoperitoneal shunt

Migration of peritoneal catheter into the abdominal cavity is rare. We have discussed and presented the treatment options in two cases with accompanying literature. Abdominal migration of peritoneal catheter appears as a result of shunt fracture and disconnection. The complaints on presentation in the abdominal cavity migration of peritoneal catheter are due to shunt dysfunction and peritoneal irritation. The peritoneal catheter with abdominal migration should be removed in cases where abdominal symptoms are present. This procedure may be easily performed laparoscopically with a single mini incision. In some cases, the catheter may cause adhesions to the intra-abdominal organs. Forcefully pulled catheters may result in organ injuries. One should therefore switch to laparotomy in these cases.