Laparoscopic Treatment of Ventriculoperitoneal Shunt Complication Caused by Distal Catheter Isolation Inside the Falciform Ligament

Displacement of peritoneal end of a shunt tube to pleural cavity: A case report

BACKGROUND

The common treatment for hydrocephalus is insertion of a ventriculoperitoneal shunt. Shunt tube displacement is one of the common complications. Most shunt tube displacements occur in children and has a reportedly lower incidence in adults.

CASE SUMMARY

This study reports an adult patient (male, 56 years) who suffered from intracranial aneurysm and subarachnoid hemorrhage and underwent aneurysm clipping following hospitalization. One month post onset of the disease, the patient underwent ventriculoperitoneal shunt due to hydrocephalus. The peritoneal end of the shunt tube was displaced in the peritoneal cavity 9 years after the aneurysm clipping. The peritoneal end of the shunt tube was removed and ventriculoperitoneal shunt was re-performed after anti-inflammatory treatment.

CONCLUSION

Shunt tube displacement has a low incidence in adults. In order to avoid shunt tube displacement, there is a need to summarize its causative factors and practice personalized medicine.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective

There have been many reports on migration of the distal catheter of the ventriculoperitoneal shunt (VPS) since this phenomenon was recognized 50 years ago. However, there have been no attempts to analyze its different patterns or to assess these patterns in terms of potential risk to patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and identified three different anatomical patterns of migration based on catheter extension and organs involved: (1) internal, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (outside the body); and (3) compound, when the catheter penetrates a hollow viscus and protrudes through a pre-existing anatomical orifice. We also analyzed the association between each migration type and several key factors. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion. Shunt duration was a critical factor in the migration pattern, as most newly-replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation, since they were most often associated with intracranial infections. The organ involved in compound migration could determine the route of extrusion, as the bowel was involved in all trans-anal migrations and the stomach in most trans-oral cases. Clin. Anat. 30:821-830, 2017. © 2017Wiley Periodicals, Inc.