Umbilical CSF fistula: a rare complication of ventriculoperitoneal shunt

Summary An umbilical CSF fistula following a ventriculoperitoneal shunt is an extremely rare complication. We report a 28-year-old man who presented with leak of clear fluid from the umbilicus, one month after a ventriculo-peritoneal shunt revision. Shuntogram revealed communication between umbilicus and abdominal end of the catheter. He was managed successfully with shunt exteriorization, antimeningitic treatment, and later shunt re-insertion.     

Ventriculo-peritoneal shunt pseudocyst causing ureteropelvic junction obstruction in a child with myelomeningocele and retrocaval ureter

We report on a boy with myelomeningocele and a ventriculo-peritoneal shunt, who presented with progressive ureteropelvic junction obstruction and an enlarging right upper quadrant mass. Exploration revealed a large pseudocyst around the distal portion of the shunt, causing obstruction of an unsuspected retrocaval ureter. To our knowledge this is the first reported case of an upper urinary tract complication due to a ventriculo-peritoneal shunt as well as the first case of a retrocaval ureter associated with myelomeningocele.     

"Missing tube" of peritoneal shunt: migration of the whole system into ventricle.

Migration of the whole shunting system of a ventriculo-peritoneal shunt into the lateral ventricle of a three-month-old male infant is presented. This is a very rare complication of ventriculo-peritoneal shunt.     

Anterior optic pathways compression by a surgical clip mobilized by delayed chronic hydrocephalus after treatment of a ruptured anterior communicating artery aneurysm

Chronic hydrocephalus is a classic and recognized complication that affects 6 to 37% of patients with aneurysmal subarachnoid haemorrhage. The diagnosis is often mentioned due to the delayed onset of gait disturbance and slower psychomotor performance. The CT-scan confirms the diagnosis by showing an enlargement of the ventricles. In case of symptomatic hydrocephalus, a ventriculo-peritoneal shunt is often required. The authors report a rare case of chronic hydrocephalus presenting with visual symptoms, due to the delayed mobilisation of a surgical clip with direct mass effect over the anterior optic pathways. The treatment of hydrocephalus led to a rapid and complete regression of symptoms.     

Case report of symptomatic cholelithiasis after ventricular cholecystic shunt

Hydrocephalus is a prevalent problem in the pediatric population, and patients with ventriculo-peritoneal shunts are often encountered. The use of ventricular cholecystic shunts is an option for patients who are unable to have a ventriculo-peritoneal shunt. This is a case report that describes a late complication of a ventricular cholecystic shunt. Eleven years after insertion of a ventricular cholecystic shunt, the patient developed cholelithiasis encrusted on shunt tubing. The shunt was revised, and 6 months follow-up has shown relief of symptoms and no further evidence of cholelithiasis.     

Massive acquired omental cyst as a complication of ventriculo-peritoneal shunting

A case of massive acquired omental cyst in a 13-year-old girl as a complication of ventriculo-peritoneal (VP) shunting is reported. This is the first such case to be reported. Most complications of VP shunting involve shunt blockade, infection, or both. The absence of shunt blockade, infection or inflammation, and associated symptoms in this case permitted the acquired omental cyst to reach a massive size before detection; the cyst was managed successfully by simple resection of a large part of its thin wall.     

Cerebrospinal fluid pseudocyst of the breast

A 39 year old lady presented with a lump in her right breast. She was known to have had a ventriculo-peritoneal shunt inserted for childhood hydrocephalus. Mammography revealed a calcified, fractured shunt with an associated soft tissue swelling which resolved following shunt removal. Shunt fracture secondary to calcification is extremely rare, and presentation as a breast lump has not been previously described. This case identifies a rare cause of breast lumps and highlights the importance of complete triple assessment in all patients presenting with a breast lump.     

Umbilical fistula as a complication of ventriculo-peritoneal shunt

Two cases of CSF umbilical fistula in children with ventriculo-peritoneal shunt are reported. In the first at exploratory laparotomy there was a persistent umbilical vein and in the second a diffuse perivisceritis. Only three cases of this complication of ventriculo-peritoneal shunt have been reported in the literature.     

A case of glomerulonephritis associated with ventriculo-atrial shunt

Nephritis associated with a chronically infected ventriculo-atrial (VA) or ventriculo-peritoneal (VP) shunt is known as shunt nephritis. A 60-year-old woman who had a VA shunt implanted for hydrocephalus began to show intermittent low-grade fever of an unknown origin, as well as hypertension and lower leg edema. Laboratory findings showed renal insufficiency with proteinuria, and a percutaneous renal biopsy was performed. Light microscopy revealed findings of membranoproliferative glomerulonephritis. Shunt nephritis was suspected. The VA shunt was removed and the VP shunt was replaced subsequently. Signs of renal impairment were recovered after surgery. However, a new VA shunt was implanted because of a shunt malfunction. Shunt nephritis is a rare complication associated with shunt system implantation. It can be treated successfully by removing the shunt system immediately. It should be considered that shunts, especially VA shunts, always carry a risk of nephritis.     

Subdural hygroma: a rare complication of spinal anesthesia

IMPLICATIONS: We describe a patient with frontal hygroma after spinal anesthesia--a rare complication. This condition should be considered in patients after spinal anesthesia with persisting orthostatic headache. Risk factors include ventriculo-peritoneal shunt or brain atrophy caused by old age.     

Abdominal wall hernia: an uncommon complication of in utero vesicoamniotic shunt placement

Three cases are reported in which placement of a vesicoamniotic shunt in utero for the treatment of obstructive uropathy led to the rare complication of abdominal wall hernia. All 3 patients underwent vesicoamniotic shunt placement for severe oligohydramnios and a markedly dilated bladder in an effort to preserve renal function and to prevent pulmonary hypoplasia. All three shunts were initially placed at or above the umbilicus. The abdominal wall hernias were closed postnatally at the time of temporary vesicostomy for urethral obstruction. All 3 patients had sufficient pulmonary development, but 2 of 3 had renal failure, requiring dialysis. Management and potential etiology of this rare complication are discussed.     

Hypertensive pneumocephalus and nasal fistula in ventriculo-peritoneal shunt: case report and review of literature

A case of hypertensive endoventricular pneumocephalus associated with rhinoliquorrea raised after about 2 years from the application of ventriculo-peritoneal shunt for hydrocephalus by stenosis of aqueduct is presented. The causes of such complication and diagnostic possibilities to point out the fistula by CT and ventricular cisternography are to talk over. Even the indication of external CSF drainage or to the repairing treatment will be discussed. Finally, literature is reviewed.     

Pneumothorax après mise en place d''une dérivation ventriculo-péritonéale

A respiratory distress syndrome is reported in a four month old girl, after placement of a ventriculo-peritoneal shunt for hydrocephalus. This complication was related to a surgical pneumothorax. It was an early and spontaneously resolving complication, which one should have in mind after shunting procedures.     

Pasteurella multocida: a rare case of shunt infection

Pasteurella multocida, the major pathogen following an animal bite, is a rare cause of intracranial infection. This report documents the first case of ventriculo-peritoneal shunt infection with Pasteurella multocida.     

Large abdominal pseudocyst as a complication of ventriculoperitoneal shunt--diagnosis by ultrasonography and whole body CT scan (author's transl)]

We report a case in which a large abdominal pseudocyst developed following a ventriculo-peritoneal shunt (V-P shunt) for hydrocephalus due to pineal germinoma. A 24-year-old man had undergone a V-P shunt and radiotheraphy for unbiopsied posterior third ventricle tumor. Four years after operation he was readmitted because of double vision, conjugate upward gaze palsy and a large abdominal mass. Preoperative diagnosis of abdominal pseudocyst was made by abdominal computed tomography and ultrasonotomography. The shunt tube was clearly deomonstrated in the cavity by computed tomography. It is suggested that, in a patient suspicious of having abdominal pseudocyst who developed abdominal symptoms and signs following V-P shunt, abdominal computed tomography and/or ultrasonotomography provide a definitive diagnosis of this entity.     

Rare complication in the surgical therapy of hydrocephalus with ventriculo-peritoneal shunt

Two cases of an unusual complication in ventriculo-peritoneal shunt for childhood's hydrocephalus are described. Migration of the distal part of shunt into peritoneal cavity was observed. Symptomatology, diagnostic and treatment are reported.     

Duplicated peritoneal catheter as a cause of shunt malfunction. Case report

A rare example of ventriculo-peritoneal shunt malfunction is presented. Radiological and operative findings demonstrated a selfduplication with upward migration of the peritoneal catheter.     

The peritoneal complications of ventriculo-peritoneal shunts.

One hundred and two patients with ventriculo-peritoneal shunts were studied. The aim of the study was to record the complications caused by the peritoneal end of the catheter and the frequency with which they occurred. Some of the complications involving tube migration are illustrated by case reports emphasizing the possible morbidity adn mortality that may be associated with this problem. Fity-one patients in the series had a complication; of these, 23 had only a mild temporary intestinal ileus following initial insertion of the shunt system. In the remaining 28 patients, the complications could have been significantly reduced by careful attention to operative detail and a closer follow-up of the patients following the shunt insertion.     

Central nervous cryptococcosis giving rise to ascites after ventriculo-peritoneal shunting--a case report

The ascites retention as a complication after ventriculo-peritoneal shunting (V-P shunt) is very rare. In this paper, a case of central nervous cryptococcosis giving rise to ascites after a V-P shunt is presented. A 45-year-old female was referred to Prefectural Gifu Hospital complaining of nausea and disturbance of recent memory. She had no remarkable medical history. CT scan films on admission showed enlarged ventricles except for the fourth ventricle, indicating an obstructed hydrocephalus. Lumbar cerebrospinal fluid (CSF) examinations revealed an increase in cell counts (mostly lymphocytes) and protein content, and positive Pandy and Nonne-Apelt reactions. Based on this information, it was tentatively suggested that she had a certain infection in the central nervous system such as mycosis or tuberculosis etc. Continuous ventricular drainage was performed for about three weeks. During this period, several lumbar and ventricular CSF cultures were negative. Therefore, a V-P shunt operation was performed. However, about seven weeks after the V-P shunt, she developed abdominal distention without any peritoneal signs. Abdominal CT scan films showed an abnormal ascites retention. Laboratory tests revealed positive CRP and increased ESR values. Again, it was suggested that she had not only a central nervous but also a peritoneal infection giving rise to ascites. From samples of ventricular CSF and ascites, cryptococcus neoformans was cultured. The lumbar CSF revealed positive latex agglutination titer for cryptococcal antigen, although the culture was negative. The ascites examination revealed an increase in cell counts (mostly lymphocytes) and protein content, and positive Rivalta and Runneberg reactions.(ABSTRACT TRUNCATED AT 250 WORDS)     

THE PERITONEAL COMPLICATIONS OF VENTRICULO-PERITONEAL SHUNTS1

One hundred and two patients with ventriculo-peritoneal shunts were studied. The aim of the study was to record the complications caused by the peritoneal end of the catheter and the frequency with which they occurred. Some of the complications involving tube migration arc illustrated by case reports emphasising the possible morbidity and mortality that may be associated with this problem. Fifty-one patients in the series had a complication; of these, 23 had only a mild temporary intestinal ileus following initial insertion of the shunt system. In the remaining 28 patients, the complications could have been significantly reduced by careful attention to operative detail and a closer follow-up of the patients following the shunt insertion.