Stenotrophomonas maltophilia as a rare cause of meningitis and ventriculoperitoneal shunt infection

Stenotrophomonas maltophilia is an extremely rare pathogen responsible for ventriculoperitoneal shunt infection and meningitis. This young female patient with history of multiple shunt revisions in the past, came to us with shunt dysfunction and exposure of the ventriculoperitoneal shunt tube in the neck. The abdominal end of the shunt tube was seen migrating into the bowel during shunt revision. The cerebrospinal fluid analysis showed evidence of Stenotrophomonas maltophilia growth. This is the first reported case of Stenotrophomonas maltophilia meningitis associated with ventriculoperitoneal shunt migration into the bowel.

Multizone Openhole Gravel Packing with Enhanced Shunt Screens and Zonal Isolation in High-Rate Gas Wells

A reliable single-trip openhole multizone completion can significantly lower capital expenditure (CAPEX) by reducing rig time and well count. Recent improvements in openhole packers and enhanced shunt screen technology have enabled multizone openhole gravel pack completions with complete zonal isolation. A multizone openhole gravel-pack completion was installed in the Julimar Field with an enhanced shunt screen system, shunted mechnaical packers (SMP) and shunt tube isolation valves (STIV), to provide improved operating pressure envelope and erosion tolerance. Well design was tailored to derisk the installation and optimize performance of the multizone completion. Extensive reliability testing was undertaken on all new technology for this project. Completions were installed as planned, and the main objectives of sand control integrity, production attainment, and complete zonal isolation with selective production were validated through post-job gravel-pack analysis and subsequent well unloading. The successful implementation of these technologies significantly reduced project CAPEX and enabled access to reserves that would otherwise have been uneconomical to recover. This paper discusses design, execution, and evaluation of the multizone openhole gravel pack (OHGP) completions installed in the Julimar Field. This includes methodology followed for multizone completion selection, development of a new high-temperature formate-based viscous gravel-pack carrier fluid, detailed completion equipment qualification tests, post-job gravel-pack evaluation, and initial well performance from well unload. It is the industry's first field case study of enhanced shunt screens with novel shunt tube isolation valves and high-temperature xanthan-based gravel-pack carrier fluid.

An Indigenous Method of Securing Ventriculoperitoneal Shunt Tube in Peritoneal Cavity

Introduction Ventriculoperitoneal shunt (VPS) is the most common procedure used for cerebrospinal fluid (CSF) diversion in hydrocephalus. Over the years, many technical, procedural, and instrument-related advancements have taken place which have reduced the associated complication rates. Shunt block is a very common complication irrespective of the shunt system used. The abdominal end of the shunt tube gets blocked usually due to plugging of omentum onto the shunt catheter. We describe a technique of catheter fixation and placement under vision coupled with omentopexy done laparoscopically to prevent this complication. Materials and Methods This technique was used in 23 patients (11 female, 12 male; range 16–73 years) afflicted with hydrocephalus from June 2016 and December 2019 after obtaining an informed consent, and the outcomes were noted in terms of shunt patency, complications, if any, and the need for revision. Results The median operation time was 90 minutes (range 35–160 minutes). All shunt catheters were still functional after a mean follow-up of 16.5 months (range 1–34 months) and none required revision. Conclusion Laparoscopic placement of shunt tube along with omental folding is a safe and effective technique for salvaging the abdominal end of VPS and may be helpful in reducing shunt blockage.

Endoscopic antegrade aqueductoplasty and stenting with panventricular catheter in management of trapped fourth ventricle in patients with inadequately functioning supratentorial shunt

Background: Trapped fourth ventricle (TFV) usually develops as a complication of supratentorial ventricular CSF shunting, especially when hydrocephalus is caused by intraventricular hemorrhage and/or infection. This study aimed to assess the feasibility of endoscopic aqueduct stenting using a single refashioned shunt tube to treat cases presenting with both TFV and shunt malfunction. Methods: We retrospectively collected and analyzed data from patients presenting with TFV and supratentorial shunt malfunction who underwent endoscopic aqueduct stenting using a refashioned shunt tube. All cases were treated at our institution between January 2010 and July 2019. The surgical technique is described. Results: Eighteen patients were enrolled in our study. There were ten males and eight females. The mean age was 11.2 years (range = 1–33 years). Headache, nausea, and vomiting were the most common clinical presentations. The mean duration of follow-up was 22.1 months (range = 6–60 months). All cases showed clinical and radiological improvement after surgery. Conclusion: Endoscopic antegrade aqueductoplasty and stenting with the refashioned panventricular shunt catheter are an adequate treatment option for both TFV and supratentorial shunt malfuncion.