scholarly journals Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient

2021 ◽  
Vol 55 (4) ◽  
pp. 322
Author(s):  
Asra Al Fauzi ◽  
Muhammad Arifin Parenrengi ◽  
Joni Wahyuhadi ◽  
Eko Agus Subagio ◽  
Agus Turchan
Keyword(s):  
Risk Factors ◽  
Adult Patient ◽  
Bowel Perforation ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Acute Subdural Hematoma ◽  
Vp Shunt ◽  
Catheter Migration ◽  
Shunt Catheter ◽  
Old Adult

The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.

scholarly journals Case Report: Ventriculoperitoneal Shunt Catheter Migration and Transanal Extrusion in Persistent Vegetative State Adult Patient

2020 ◽  
Vol 55 (4) ◽  
pp. 322
Author(s):  
Asra Al Fauzi ◽  
Muhammad Arifin Parenrengi ◽  
Joni Wahyuhadi ◽  
Eko Agus Subagio ◽  
Agus Turchan
Keyword(s):  
Risk Factors ◽  
Adult Patient ◽  
Bowel Perforation ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Acute Subdural Hematoma ◽  
Vp Shunt ◽  
Catheter Migration ◽  
Shunt Catheter ◽  
Old Adult

The complications of ventriculoperitoneal (VP) shunts are many and are reported in literature extensively. The complication of transanal extrusion after bowel perforation is known although rare. This complication is very well described amongst the children. The authors describe the case of bowel perforation and transanal extrusion of a VP shunt occurring in a 51-year-old adult patient. The patient has a history of craniotomy for acute subdural hematoma after severe head injury one year ago continued with VP shunt for post-traumatic hydrocephalus. Home care with bedridden conditions is done at home until finally, the family gets the catheter extrude from the transanal. Bowel perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The exact pathogenesis of shunt-related organ perforation and extrusion through the anus is unclear, and various mechanisms have been suggested, Among many factors, age is the prominent factor for bowel perforation.1 Because of weak bowel musculature and stronger peristaltic activity, children are more susceptible to bowel perforation than adult patients. In adult shunted patient, one of the risk factors is related to PVS with chronic immobilization, as described in this case. Risk factors of bowel perforation in adult are quite distinct from children. Persistent vegetative state (PVS) with chronic immobilization is one of the risk factors to be aware of.

scholarly journals Unusual complications of ventriculo peritoneal shunt surgery

2012 ◽  
Vol 03 (03) ◽  
pp. 361-364 ◽  
Author(s):  
Ramesh Teegala ◽  
Laxmi Prasanna Kota
Keyword(s):  
Management Strategies ◽  
Shunt Malfunction ◽  
Neurosurgical Procedures ◽  
Shunt Surgery ◽  
Vp Shunt ◽  
Catheter Migration ◽  
Shunt Catheter ◽  
The Common ◽  
Mechanisms Of Migration ◽  
Ventriculo Peritoneal Shunt

ABSTRACTVentriculo peritoneal (VP) shunt surgery is one of the common neurosurgical procedures employed in the management of hydrocephalus. Numerous complications related to this procedure are reported in the literature. Peritoneal catheterrelated complications are the usual causes of the shunt malfunction. We report three unusual cases of peritoneal shunt catheter migration in children. Two cases are of anal and one vaginal extrusion. Possible mechanisms of migration and management strategies were discussed.

Colonic Complications of Ventriculoperitoneal Shunts

Neurosurgery ◽  
1983 ◽  
Vol 13 (2) ◽  
pp. 167-169 ◽  
Author(s):  
Khalil Abu-Dalu ◽  
Dov Pode ◽  
Moshe Hadani ◽  
Abraham Sahar
Keyword(s):  
Large Bowel ◽  
Bowel Perforation ◽  
Shunt Infection ◽  
Gram Negative ◽  
Ventriculoperitoneal Shunts ◽  
Vp Shunt ◽  
Shunt Catheter

Abstract Late perforation of the large bowel by the abdominal catheter of a ventriculoperitoneal (VP) shunt is extremely rare. Four of the five reported patients subsequently died. We report here three patients who presented with this complication and were treated successfully. Bowel perforation by a VP shunt catheter should be considered when a shunt infection is secondary to gram-negative enteric organisms. It can occur without evidence of peritonitis, and the abdominal catheter can be removed percutaneously, thus avoiding a laparotomy.

Improved outcome prediction based on CSF extrapolated creatine kinase BB isoenzyme activity and other risk factors in severe head injury

1989 ◽  
Vol 71 (1) ◽  
pp. 54-58 ◽  
Author(s):  
Pol Hans ◽  
Adelin Albert ◽  
Colette Franssen ◽  
Jacques Born
Keyword(s):  
Risk Factors ◽  
Creatine Kinase ◽  
Head Injury ◽  
Severe Head Injury ◽  
Outcome Prediction ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Significant Risk ◽  
Thoracic Injury ◽  
Creatine Kinase Bb

✓ The present study of 43 patients with severe head injury shows that outcome prediction can be markedly improved by combining an appropriate marker of the degree of initial brain damage and other risk factors. The patients were classified into three groups according to their actual outcome after 6 months: death (22 patients); persistent vegetative state or severe disability (eight patients); and moderate disability or good recovery (13 patients). By applying stepwise logistic discriminant analysis to the patients' data, five significant risk factors were selected: degree of neurological damage assessed by cerebrospinal fluid (CSF) extrapolated creatine kinase BB isoenzyme activity, Glasgow-Liege Coma Scale score, age, incidence of thoracic injury, and intracranial pressure (ICP). Extrapolated creatine kinase BB activity had the highest prognostic ability (67%). Uncontrollable elevated ICP proved to be systematically associated with death, whereas its absence was not necessarily indicative of a favorable outcome. The combination of the five variables yielded a total prognostic efficiency of 91%. The percentages of correctly predicted patients for the three outcome groups were, respectively, 100%, 50%, and 100%. Thus, half of the persistently vegetative and severely disabled patients were identified by the selected factors.

Documented reversal of global ischemia immediately after removal of an acute subdural hematoma

1994 ◽  
Vol 80 (2) ◽  
pp. 324-327 ◽  
Author(s):  
Marc L. Schröder ◽  
J. Paul Muizelaar ◽  
A. John Kuta
Keyword(s):  
Subdural Hematoma ◽  
Severe Head Injury ◽  
Motor Response ◽  
Cerebral Blood Volume ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Acute Subdural Hematoma ◽  
Good Recovery ◽  
Content Type ◽  
Global Values

✓ The authors report two cases of severe head injury with acute subdural hematoma, in which cerebral blood flow (CBF) and cerebral blood volume (CBV) measurements were obtained prior to evacuation of the subdural hematoma and again immediately after removal. The first patient, a 21-year-old man with a motor response localizing to pain, had a global CBF of 18.2 ml/100 gm/min and a decreased global CBV of 3.7 ml/100 gm at 2.3 hours after injury. Immediately after removal of the subdural hematoma (8.1 hours after injury), CBF and CBV measurements revealed increases to 35.5 ml/100 gm/min and 5.8 ml/100 gm, respectively. The second patient, a 49-year-old woman with a normal flexor motor response to pain, had preoperative global values of 15.8 ml/100 gm/min for CBF and 2.0 ml/100 gm for CBV at 3 hours after injury. Postoperatively (9.3 hours after injury), the CBF and CBV values increased to 41.6 ml/100 gm/min and 4.0 ml/100 gm, respectively. The first patient, with only borderline ischemia and removal of the subdural hematoma within 3 hours, made a good recovery, while the second patient, with prolonged lower levels of CBF, remained in a persistent vegetative state. The low values of preoperative CBV argue for compression of the microcirculation as the cause of ischemia.

Comparison of Decompressive Craniotomy by Wide Opening of Dura with Multidural Fenestrations Technique among Acute Subdural Hematoma Patients: A Randomized Control Trial

2018 ◽  
Vol 4 (2) ◽  
pp. 75-81
Author(s):  
Kalim Uddin ◽  
SK Sader Hossain ◽  
Md Abdus Salam ◽  
Mohammad Ashraful Haque ◽  
Mohammad Mahfuzur Rahman ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Severe Disability ◽  
Acute Subdural Hematoma ◽  
Good Recovery ◽  
Decompressive Craniotomy ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Surgical treatment is very crucial for the acute subdural hematoma patients.Objective: The purpose of the present study was to compare outcome of decompressive craniotomy with wide opening of dura and multidural fenestration technique.Methodology: This non-randomized clinical trial was carried out in the Neurosurgery Department of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2011 to August 2012 for a period of one year and eight months. Patients with acute subdural hematoma who fulfil the inclusion criteria for surgery and got admitted were selected as study population. Acute Subdural hematoma patient of any age, both sex with GCS 5 to 13, thickness of hematoma more than l0 mm, midline shift more than 5 mm, pupil reacting to light and patient presented within 72 hours of injury were included for this study. At admission, a detailed history of the illness was taken from the patient or attendant, thorough general and neurological examinations were carried out and were recorded. Specific treatment of head injury started and surgery done, cases were divided into two groups on the basis of surgical technique. Operative details, regular follow-up and post-operative CT scan findings were recorded. Finally GOS scoring done on the day of discharge of patient from the hospital.Result: A total number of 48 patients were recruited of this study of which 25 were in group A and the rest 23 patients were in group B. In group A, according to GOS Score, good recovery was 48%, moderate disability 16%, severe disability (8%), persistent vegetative state 4% and 24% patients died. In group B, good recovery was 47.83%, moderate disability 13.04%, severe disability 4.35%, persistent vegetative state 13.04% and 21.74% patients died. The mean duration of surgery was l26.32±24.86 minutes in group A and 90.95±l8.64 in group B and this difference was highly significant (P<0.00l). In addition, the mean duration of hospital stay was 23.44(±6.65) days in group A and 16.26(±4.63) days in group B and this difference between two group was statistically significant (P<0.001).Conclusion: In conclusion multiple dural fenestrations is an effective decompressive procedure for removal of acute subdural hematomaJournal of National Institute of Neurosciences Bangladesh, 2018;4(2): 75-81

Persistent vegetative state in head injury

2005 ◽  
Vol 2 (2) ◽  
pp. 81-85
Author(s):  
Deepak Kumar Gupta ◽  
AK Mahapatra
Keyword(s):  
Head Injury ◽  
Vegetative State ◽  
Persistent Vegetative State

scholarly journals Persistent vegetative state: an overview

2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Gabriel Alexander Quiñones-Ossa ◽  
Yeider A. Durango-Espinosa ◽  
Tariq Janjua ◽  
Luis Rafael Moscote-Salazar ◽  
Amit Agrawal
Keyword(s):  
Intensive Care ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Clinical History ◽  
Main Body ◽  
Disorder Of Consciousness ◽  
Family Perspective ◽  
Patient Status ◽  
History Of ◽  
State Diagnosis

Abstract Background Disorder of consciousness diagnosis, especially when is classified as persistent vegetative state (without misestimating the other diagnosis classifications), in the intensive care is an important diagnosis to evaluate and treat. Persistent vegetative state diagnosis is a challenge in the daily clinical practice because the diagnosis is made mainly based upon the clinical history and the patient behavior observation. There are some specific criteria for this diagnosis, and this could be very tricky when the physician is not well trained. Main body We made a literature review regarding the persistent vegetative state diagnosis, clinical features, management, prognosis, and daily medical practice challenges while considering the bioethical issues and the family perspective about the patient status. The objective of this overview is to provide updated information regarding this clinical state’s features while considering the current medical literature available. Conclusions Regardless of the currently available guidelines and literature, there is still a lot of what we do not know about the persistent vegetative state. There is a lack of evidence regarding the optimal diagnosis and even more, about how to expect a natural history of this disorder of consciousness. It is important to recall that the patients (despite of their altered mental state diagnosis) should always be treated to avoid some of the intensive care unit long-stance complications.

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