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.     

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.     

Unusual abdominal complication of ventriculoperitoneal shunt

The most common complications after CSF shunting to treat hydrocephalus are shunt infection and obstruction. Although ventriculoperitoneal (VP) diversion of the CSF using artificial shunt devices is an accepted method for the management of hydrocephalus, high rates of various complications have been reported, ranging from 24% to 47%. Among these, abdominal complications account for approximately 25%. The incidence of bowel perforation by shunt-catheter is known to be as low as 0.1-0.7%. We describe a case of migration af a peritoneal catheter through a congenital hernia of Morgagni.     

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.     

Urethral extrusion of a peritoneal catheter in a patient with a neobladder: a rare complication of shunt insertion

The insertion of a ventriculoperitoneal shunt (VPS) is considered the standard of care for several forms of hydrocephalus. Abdominal complications are most common with this procedure, comprising up to 30% of all shunt-related problems. Conversely, visceral perforation or extrusion of the shunt apparatus is rare. Herein we report a rare complication of VPS insertion in which the peritoneal catheter was spontaneously extruded through the urethra of a patient with a neobladder. We further discuss the pathogenesis, diagnosis, and treatment of this condition.     

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.     

Cerebrospinal fluid ascites: a complication of a ventriculoperitoneal shunt

A 1 year old Caucasian male born with an omphalocoele, malrotation of the large bowel, and Ladd's bands developed an E. coli wound infection and subsequent meningitis-ventriculitis which responded to antibiotic therapy. Aqueductal stenosis and obstructive hydrocephalus initially was treated with a ventriculoperitoneal shunt. After a routine diphtheria-pertussis-tetanus immunization, the child developed a CSF ascites which resolved following a ventriculoatrial shunt.     

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.     

Umbilical perforation: an unusual complication of a ventriculoperitoneal shunt

Introduction Ventriculoperitoneal shunt operations are the most common pediatric neurosurgical procedures in the treatment of hydrocephalus. However, ventricular shunting is frequently associated with a wide variety of complications. Umbilical perforation is an extremely rare complication of ventriculoperitoneal shunts.Case report We present an infant with umbilical abscess, meningitis, and umbilical perforation of the distal end of the ventriculoperitoneal shunt, which was placed for congenital hydrocephalus.     

Retrograde migration of the abdominal catheter as a complication of ventriculoperitoneal shunts: the fishhook sign

Three cases of retrograde migration of the distal catheter of ventriculoperitoneal shunts into the subcutaneous fibrous tract of the thoracic wall are reported. To the authors' knowledge this is the first time that this complication of ventriculoperitoneal shunts has been described.     

Torticollis as a late complication of ventriculoperitoneal shunt surgery

The pathophysiological mechanisms related to aging of the material of a ventriculoperitoneal (VP) shunt and how mechanical stresses and mechanical traction applied to the VP shunt catheter contributed to the development of torticollis are discussed. We report a 14-year-old boy with torticollis developing as a late complication 12 years after placement of a left VP shunt for the treatment of aqueductal stenosis. The shunt tube and the surrounding fibrocalcified band were removed, and the patient’s torticollis resolved completely without recurrence. Biomechanical dysfunction of shunt material with resultant tethering at the most mobile part of the shunt tubing (neck) in a growing child can lead to the development of torticollis. To our knowledge this is the first report of this VP shunt complication.     

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.     

腹腔端微创置管技术在脑室-腹腔分流术中的应用（附85例分析）

目的探讨在不用腹腔镜的情况下,微创分流管腹腔端置管技术在脑室-腹腔分流术中的安全性和可行性。方法回顾性分析85例采用微创分流管腹腔端置管技术病人的手术指征、手术技巧及并发症等。本组采用人工气腹,腹部行5mm小切口,在不使用腹腔镜的情况下置入分流管腹腔端。结果术后发生颅内感染2例,脑室端梗阻2例,脑室端异位’1例和腹腔端包裹性积液1例,无腹腔端异位或腹腔脏器损伤发生。结论微创分流管腹腔端置管技术安全有效,具有操作简单、损伤轻微、节省医用资源、减少费用、并发症少等特点,易于在各级医院开展。     

Intratumoral abscess: an unusual complication of ventriculoperitoneal shunt infection

Introduction Ventriculoperitoneal shunts were routinely used in the past in children with posterior fossa tumors and hydrocephalus. They can, however, cause a multitude of problems.Case report This report highlights a previously unencountered phenomenon of a pyogenic abscess forming within a posterior fossa ependymoma as a result of shunt infection. The shunt was exteriorized and the child treated with antibiotics before surgery was done. Only a partial excision of the tumor was possible, as the inflammatory response caused by the abscess had obliterated tissue planes.     

Cerebrospinal fluid galactorrhea: a rare complication of ventriculoperitoneal shunting.

In this report we describe a 26-year-old woman who had an intra-abdominal pseudocyst located at the peritoneal catheter tip following ventriculo-peritoneal (VP) shunt implantation. Retrograde cerebrospinal fluid (CSF) flowed outside the catheter and communicated with the right breast lactiferous ductal system and leaked from the nipple orifice. CSF galactorrhea only occurs when the lactiferous duct is injured during VP shunt implantation, in combination with the formation of an intra-abdominal CSF pseudocyst prior to lactiferous duct healing. Leakage of CSF from the nipple orifice can be successfully treated by simply guiding the peritoneal catheter tip into the peritoneal cavity through a new laparotomy; that is, shunt revision is not always required.     

CSF hydrothorax after ventriculoperitoneal shunt without catheter migration: a case report

Ventriculoperitoneal (VP) shunting is the most common procedure performed for the management of hydrocephalus. VP shunt related complications remain a persistent problem in current clinical practice. Five-year-old female patient was admitted to our hospital with persistent dyspnea complaint. The patient was operated at the age of 3 months and a VP shunt established in a different clinic due to hydrocephalus associated with Dandy-Walker malformation. The patient’s chest X-ray revealed right sided pleural effusion. Thorasentesis was performed and the effusion was drained with a chest tube. The discharged liquid was consistent with CSF. Scintigraphic radionuclide shunt analyses were performed and CSF passage from abdomen to chest and lower mediastinal region was determined in the late static images. The patient was operated and the incorporated ventriculoperitoneal shunt was removed. Hydrothorax was completely resolved after early postoperative stage. CSF hydrothorax especially without catheter migration is an unusual but potentially serious-clinical complication.     

Intracardiac migration of the distal catheter of ventriculoperitoneal shunt: a case report

Introduction

Migration of the distal catheter into the heart is an extremely rare complication of ventriculoperitoneal shunt, with only 11 cases reported in literature; in only four of them, there was also the migration into the pulmonary artery. The authors report the case of a young patient with this rare complication that was managed simply converting the ventriculoperitoneal shunt into a ventriculoatrial shunt.

Discussion

The migration of the distal catheter occurred through the internal jugular vein probably as the consequence of direct damage of the vessel during tunneling. Venous flow and negative intrathoracic pressure may have gradually pulled the catheter up into the heart; the upward migration may also be encouraged by the continuous movements of the patient that was agitated in the postoperative period as the consequence of her psychiatric disorder. The authors review the literature regarding migration of distal tubing into the heart and pulmonary artery. Diagnosis and management of this complication is discussed.     

脑室-腹腔分流术并发症的防治

作为治疗脑积水的一种主要手段,脑室-腹腔分流术虽然操作简单,但并发症发生率较高成为困扰临床医师的棘手问题。本文总结了作者采用脑室-腹腔分流术治疗脑积水的经验并分析了各种并发症的产生原因,提出一些预防和治疗的方法,以期提高脑室-腹腔分流术的成功率,减少并发症,改善患