scholarly journals Subgaleal Migration of the Distal Catheter of a Ventriculoperitoneal Shunt

2009 ◽  
Vol 52 (2) ◽  
pp. 77-79 ◽  
Author(s):  
Fatih Serhat Erol ◽  
Bekir Akgun
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Shunt Valve ◽  
Distal Catheter ◽  
X Ray ◽  
Proximal Migration ◽  
Shunt Dysfunction ◽  
Valve Placement ◽  
The Brain

Proximal migration of the distal end of a ventriculoperitoneal shunt has been observed much more rarely than other numerous shunt-related complications. Subgaleal migration of the peritoneal end is one of the samples. In the preset report we have discussed a case of subgaleal migration of the peritoneal end detected as a result of the examinations performed for shunt dysfunction. There was ventricular dilatation on CT scan of the brain. X-ray examinations confirmed proper ventricular catheter and shunt valve placement but a complete migration of distal (peritoneal) catheter into the subgaleal space. Then the patient’s shunt was revised. When our case and the literature were examined, we observed that this complication was frequently encountered during the first postoperative months, in the pediatric ages and in patients with advanced hydrocephalus. Besides, we have detected that the peritoneal catheters had tendency to migration into the subgaleal tissues similar to pre-insertion forms of the preoperatively original packages.

Ventriculosagittal Sinus Shunt Placement: Technical Case Report

Neurosurgery ◽  
2003 ◽  
Vol 53 (3) ◽  
pp. 778-780 ◽  
Author(s):  
Uzma Samadani ◽  
Julian A. Mattielo ◽  
Leslie N. Sutton
Keyword(s):  
Clinical Presentation ◽  
Air Embolism ◽  
Pneumatosis Intestinalis ◽  
Seldinger Technique ◽  
Ventricular Catheter ◽  
Shunt Valve ◽  
Distal Catheter ◽  
Shunt Placement ◽  
Sagittal Sinus ◽  
Theoretical Advantage

Abstract OBJECTIVE AND IMPORTANCE Determining an appropriate site for distal catheter placement for ventricular shunting for some hydrocephalic patients can be difficult. We describe a simplification of the technique for sagittal sinus shunt placement using a guidewire. CLINICAL PRESENTATION A 20-month-old infant with hydrocephalus secondary to Alexander's disease developed erosion of her parieto-occipital ventriculoperitoneal shunt reservoir through an occipital decubitus scalp ulceration. Her hydrocephalus was temporarily treated with a ventriculostomy; however, she developed pneumatosis intestinalis while in the hospital. TECHNIQUE The patient underwent placement of a ventriculosagittal sinus shunt. The ventricular catheter and shunt valve were placed through a burr hole at Kocher's point, and the distal end of the catheter was placed in the superior sagittal sinus by using the Seldinger technique. CONCLUSION Ventriculosagittal sinus shunting may be used as an alternative to traditional methods for patients for whom distal shunt placement is problematic. Our technique has the theoretical advantage of reducing the risks of blood loss or air embolism by not requiring a scalpel incision into the sinus.

scholarly journals Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases

2021 ◽  
Vol 2 (17) ◽  
Author(s):  
Lacey M. Carter ◽  
Alejandro Ruiz-Elizalde ◽  
Naina L. Gross
Keyword(s):  
Pediatric Surgery ◽  
Umbilical Hernia ◽  
Case Reports ◽  
Shunt Revision ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Vp Shunt ◽  
Umbilical Hernia Repair ◽  
Shunt Dysfunction ◽  
Csf Absorption

BACKGROUND When ventriculoperitoneal (VP) shunts and umbilical hernias coexist in the same patient, unique complications can occur. Typically, these are readily identified problems such as cerebrospinal fluid (CSF) fistulas or entrapment of the peritoneal catheter in the hernia. The authors present cases of two children whose VP shunt dysfunction resolved after repair of their umbilical hernias. OBSERVATIONS The authors present two cases of infant patients with shunted hydrocephalus and umbilical hernias. In both cases, the patients presented with distal shunt malfunctions not due to infection. Their shunt function improved once the umbilical hernia was repaired by pediatric surgery. Neither has required shunt revision since umbilical hernia repair. LESSONS Although there are case reports of VP shunts eroding through the umbilicus, developing CSF fistulas, or becoming trapped inside umbilical hernias, there is no case of VP shunt dysfunction caused by just the presence of an umbilical hernia. The authors suspect that the catheter may intermittently enter and exit the hernia. This may cause intermittent obstruction of the distal catheter, or inflammation in the hernia may occur that limits CSF absorption.

Ventriculoperitoneal shunt with a rare twist: small-bowel ischemia and necrosis secondary to knotting of peritoneal catheter

2014 ◽  
Vol 14 (3) ◽  
pp. 234-237 ◽  
Author(s):  
Lee A. Tan ◽  
Manish K. Kasliwal ◽  
Roham Moftakhar ◽  
Lorenzo F. Munoz
Keyword(s):  
Small Bowel ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
External Ventricular Drain ◽  
Bowel Ischemia ◽  
Shunt Revision ◽  
Peritoneal Catheter ◽  
High Grade Fever ◽  
Shunt System ◽  
Distal Catheter

Small-bowel ischemia and necrosis due to knotting of the peritoneal catheter is an extremely rare complication related to a ventriculoperitoneal shunt (VPS). A 3-month-old girl, with a history of Chiari II malformation and myelomeningocele (MM) after undergoing right occipital VPS insertion and MM repair at birth, presented to the emergency department with a high-grade fever. Examination of a CSF sample obtained via shunt tap raised suspicion for the presence of infection. Antibiotic therapy was initiated, and subsequently the VPS was removed and an external ventricular drain was placed. Intraoperatively, as attempts at pulling the distal catheter from the scalp incision were met with resistance, the distal catheter was cut and left in the abdomen while the remainder of the shunt system was successfully removed. While the patient was awaiting definitive shunt revision surgery to replace the VPS, she developed abdominal distension due to small-bowel obstruction. An emergency exploratory laparotomy revealed a knot in the distal catheter looping around and strangulating the distal ileum, causing small-bowel ischemia and necrosis in addition to the obstruction. A small-bowel resection with ileostomy was performed, with subsequent placement of ventriculoatrial shunt for treatment of hydrocephalus. The authors report this exceedingly rare clinical scenario to highlight the fact that any retained distal catheter must be carefully managed with immediate abdominal exploration to remove the distal catheter to avoid bowel necrosis as pulling of a knotted peritoneal catheter may strangulate the bowel and cause ischemia, with significant clinical morbidity and possible mortality.

Minimally invasive implantation of the peritoneal catheter in ventriculoperitoneal shunt placement for hydrocephalus: analysis of data in 151 consecutive adult patients

2006 ◽  
Vol 105 (6) ◽  
pp. 869-872 ◽  
Author(s):  
Alan Bani ◽  
Dieter Telker ◽  
Werner Hassler ◽  
Matthias Grundlach
Keyword(s):  
Minimally Invasive ◽  
Ventriculoperitoneal Shunt ◽  
General Surgery ◽  
Interdisciplinary Approach ◽  
Shunt Infection ◽  
Adult Patients ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Laparoscopy Group ◽  
Shunt Placement

Object The authors report on their experience with laparoscopy-guided implantation of a peritoneal catheter in ventriculoperitoneal shunt placement procedures in adults. Methods In performing the conventional method of shunt placement in 2001, 8% of the cases resulted in malposition and dislocation of the distal catheter; therefore, the authors together with personnel from the Department of General Surgery decided to utilize an interdisciplinary approach involving laparoscopy-guided implantation of the catheter. Between October 2001 and January 2005, 202 ventriculoperitoneal shunt placement procedures were conducted in adult patients for hydrocephalus of various origins. In 152 patients, laparoscopy-guided implantation of the distal catheter was performed. In all except one of these patients, implantation was successful. Laparoscopy and the cranial part of the surgery were performed simultaneously. There was an 8% rate of malposition of the distal catheter in the nonlaparoscopy group. In contrast, there was no dislocation or malposition of the distal catheter in the laparoscopy group. Two cases (1.3%) of shunt infection occurred in the laparoscopy group. Conclusions Laparoscopic implantation of a distal catheter is a simple, minimally invasive, and easy procedure to perform and allows exact localization of the peritoneal catheter and confirmation of its patency.

scholarly journals Ventriculoperitoneal shunt related meningioma: a case report

2013 ◽  
Vol 20 (3) ◽  
pp. 281-285
Author(s):  
G.A. Cruz-Ortiz ◽  
A. Samano-Osuna ◽  
M. Jimenez-Jimenez ◽  
H.R. Alvis-Miranda ◽  
A. Lee ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Report ◽  
Foreign Body ◽  
Inflammatory Reaction ◽  
Ventriculoperitoneal Shunt ◽  
Clinical Case ◽  
Endogenous Hormones ◽  
Shunt Valve ◽  
Chronic Inflammatory Reaction ◽  
The Brain

Abstract Meningiomas are the most common primary, non-glial tumours of the brain and spine, and represent the most common extra-axial lesions. The typical meningioma is a dural-based, markedly enhancing extraaxial mass; they exhibit cortical buckling with trapped cerebrospinal fluid clefts or cortical vessels. There are factors strongly associated with risk of developing meningioma, as in the case of exposure to ionizing radiation, or exogenous or endogenous hormones, as in this case, the presence of shunt material as a foreign body may have contributed to oncogenesis on the basis of a chronic inflammatory reaction. The aim of this report is to present the clinical case of a meningioma, which enveloped the proximal catheter of ventriculoperitoneal shunt valve

scholarly journals A rare complication of ventriculoperitoneal shunt: Pleural effusion without intrathoracic ventriculoperitoneal shunt catheter

2020 ◽  
Vol 11 ◽  
pp. 291
Author(s):  
Said Hilmani ◽  
Tarek Mesbahi ◽  
Abderrahman Bouaggad ◽  
Abdelhakim Lakhdar
Keyword(s):  
Pleural Effusion ◽  
Ventriculoperitoneal Shunt ◽  
Rare Complication ◽  
Peritoneal Catheter ◽  
X Ray ◽  
Thoracic Drainage ◽  
Repeat Chest ◽  
Chest X Ray ◽  
The Right ◽  
Catheter Replacement

Background: Symptomatic pleural effusion following ventriculoperitoneal shunt (VPS) insertion is very rare and poorly understood in the literature in contrary to other mechanical complications. Case Description: We report a case of 15 month-year-old girl who had VP shunt for congenital hydrocephalus. Twelve months after surgery, she was diagnosed with massive hydrothorax. Chest X-ray and thoracoabdominal CT scan confirmed the right pleurisy and showed the tip of the peritoneal catheter in the general peritoneal cavity. We made thoracic drainage of the transudative pleural effusion. When we released the chest tube, 24 h after, the girl showed a respiratory distress again and the effusion resumed at the X-ray control. Her symptoms abated after the realization of a ventriculoatrial shunt “VAS.” Repeat chest X-ray confirmed the resolution of the hydrothorax. Conclusion: Despite the not yet well-understood mechanism of this rare and important VPS complication, management is simple based on X-ray confirmation, thoracentesis with biological analysis, and catheter replacement, especially in atrium “VAS.”

scholarly journals Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 71-75
Author(s):  
Matthias Gmeiner ◽  
Wolfgang Thomae ◽  
Marco Tolino ◽  
Wolfgang Senker ◽  
Andreas Gruber
Keyword(s):  
Bowel Perforation ◽  
Enteric Bacteria ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Shunt Valve ◽  
Mortality And Morbidity ◽  
Shunt Placement ◽  
Abdominal Symptoms ◽  
Ventriculoperitoneal Shunting ◽  
Retrograde Spread

AbstractBowel perforation by a peritoneal catheter (BPPC) is a serious complication after ventriculoperitoneal shunting, with high mortality and morbidity rates. This patient presented with scalp ulceration over the shunt valve at the retromastoid region 26 years after shunt placement. During revision, the catheter distal to the valve was divided in the clavicular region. As there was no cerebrospinal fluid drainage, we decided to remove the ventricular catheter and valve. The ulceration was debrided and primarily closed. Distal to the clavicle, the disconnected peritoneal catheter was encased in a fibrous, calcified tunnel. To avoid piecemeal resection with multiple incisions, the catheter was not retrieved. Two years later, the patient presented with an abscess and pus draining from the clavicular wound. Cultures were positive for enteric bacteria. BPPC with retrograde spread of infection was suspected, and abdominal computed tomography confirmed perforation. We removed the disconnected catheter, but the perforation site could not be detected during laparotomy. The patient was treated with intravenous antibiotics and recovered without complications. To minimize complications, abandoned catheters should be avoided. Otherwise, patients unnecessarily have a life-long risk of developing abdominal complications. In patients with abandoned catheters and severe abdominal symptoms, BPPC is an important differential diagnosis.

scholarly journals Dynamic Occlusion of Distal Ventriculoperitoneal Shunt Catheter after Infusion Port Placement: A New Shunt Malfunction

2021 ◽  
Vol 82 (02) ◽  
pp. e17-e20
Author(s):  
Lacey M. Carter ◽  
Camille K. Milton ◽  
Kyle P. O'Connor ◽  
Arpan R. Chakraborty ◽  
Tressie M. Stephens ◽  
...  
Keyword(s):  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Ventricular Catheter ◽  
Communicating Hydrocephalus ◽  
Port Catheter ◽  
Port Placement ◽  
Distal Catheter ◽  
Shunt Catheter ◽  
Catheter Obstruction ◽  
Close Proximity

AbstractShunt failure requiring reintervention remains a common complication of hydrocephalus treatment. Here, we report a novel cause of mechanical shunt obstruction in an adult patient: position-dependent intermittent occlusion via an infusion port catheter. A 51-year-old woman with a grade II oligodendroglioma presented in a delayed fashion following surgery with a pseudomeningocele. She underwent ventriculoperitoneal shunt placement due to communicating hydrocephalus, resolving her pseudomeningocele. Shortly thereafter, she underwent placement of a subclavian infusion port at an outside institution. Her pseudomeningocele returned. Imaging demonstrated close proximity of her port catheter to the shunt catheter overlying the clavicle. Her shunt was tapped demonstrating a patent ventricular catheter with normal pressure. She underwent shunt exploration after her pseudomeningocele did not respond to valve adjustment. Intraoperative manometry demonstrated head position-dependent distal catheter obstruction. Repeat manometry following distal catheter revision demonstrated normal runoff independent of position. Her pseudomeningocele was resolved on follow-up. To our knowledge, this is the only reported case of intermittent, position-dependent distal catheter obstruction. Shunted patients with concern for malfunction following subclavian infusion port placement should be evaluated for possible dynamic obstruction of their distal catheter when the two catheters are in close proximity along the clavicle.

Increased risk of distal ventriculoperitoneal shunt obstruction associated with slit valves or distal slits in the peritoneal catheter

1997 ◽  
Vol 87 (5) ◽  
pp. 682-686 ◽  
Author(s):  
Jeffrey W. Cozzens ◽  
James P. Chandler
Keyword(s):  
Shunt Revision ◽  
Ventricular Catheter ◽  
Peritoneal Catheter ◽  
Distal Catheter ◽  
Content Type ◽  
Vp Shunt ◽  
Increased Risk ◽  
Catheter Obstruction ◽  
Shunt Obstruction ◽  
Fine Print

✓ The authors describe a relationship between the presence of distal shunt catheter side-wall slits and distal catheter obstruction in a single-surgeon series of ventriculoperitoneal (VP) shunt revisions. Between 1985 and 1996, 168 operations for VP shunt revision were performed by the senior author (J.W.C.) in 71 patients. Indications for shunt revision included obstruction in 140 operations; overdrainage or underdrainage requiring a change of valve in 17 operations; inadequate length of distal shunt tubing resulting in the distal end no longer reaching the peritoneum in five operations; the ventricular catheter in the wrong ventricle or space, requiring repositioning in five operations; and a disconnected or broken shunt in one operation. Of the 140 instances of shunt obstruction, the blockage occurred at the ventricular end in 108 instances (77.1%), the peritoneal end in 17 (12.1%), the ventricular and the peritoneal end in 14 (10%), and in the valve mechanism (not including distal slit valves) in one (0.8%). Thus, the peritoneal end was obstructed in 31 (22.1%) of 140 cases of shunt malfunction. In every case in which the peritoneal end was obstructed, some form of distal slit was found: either a distal slit valve in an otherwise closed catheter or slits in the side of an open catheter. No instances were found of distal peritoneal catheter obstruction when the peritoneal catheter was a simple open-ended tube with no accompanying side slits (0 of 55). It is concluded that side slits in the distal peritoneal catheters of VP shunts are associated with a greater incidence of distal shunt obstruction.

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