1
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Tanaka T, Fujiwara R, Sashida R, Hirokawa Y, Wakamiya T, Michiwaki Y, Shimoji K, Suehiro E, Onoda K, Yamane F, Matsuno A. Rare complication of lumboperitoneal shunt with distal catheter migration into the inguinal hernia sac in two adults: A case report. Surg Neurol Int 2023; 14:392. [PMID: 38053705 PMCID: PMC10695460 DOI: 10.25259/sni_389_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/12/2023] [Indexed: 12/07/2023] Open
Abstract
Background Despite the proven benefits of lumboperitoneal shunt (LPS) for idiopathic normal-pressure hydrocephalus, complications such as catheter migration remain a problem. Inguinal complications of the distal catheter are rare in adults, and their management is uncertain. Herein, we present two cases of distal catheter migration into the inguinal hernia sac after LPS in adults and recommend their management. Case Description An 86-year-old man presented with inguinal swelling. In another 82-year-old man who did not show any improvement after LPS, shunt angiography revealed LPS dysfunction due to lumbar catheter occlusion and distal LPS catheter in the right inguinal hernia sac, and lumbar catheter reconstruction was performed. Both patients did not have any symptoms, except inguinal swelling, and were followed up. After 2 weeks and 4 days, the distal catheter moved into the peritoneal cavity. Conclusion Inguinal complications due to the migration of the distal catheter into the inguinal hernia sac are rare in LPS because frequent movements of the distal catheter due to trunk rotation dislodge it from the inguinal hernia sac for a short period. Urgent surgery was not recommended because the catheter was moved in a short period and the patients did not wish to undergo hernia repair.
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Affiliation(s)
- Tatsuya Tanaka
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Ren Fujiwara
- Department of Neurosurgery, Narita Tomisato Tokushukai Hospital, Tomisato, Japan
| | - Ryohei Sashida
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Yu Hirokawa
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Tomihiro Wakamiya
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Yuhei Michiwaki
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Kazuaki Shimoji
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Eiichi Suehiro
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Keisuke Onoda
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Fumitaka Yamane
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
| | - Akira Matsuno
- Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita, Japan
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2
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Topp G, Entezami P, Ambati S, Szewczyk B, Adamo MA. Cerebrospinal Fluid Leakage from Scrotum Secondary to Ventriculoperitoneal Shunt Migration. Asian J Neurosurg 2023; 18:333-335. [PMID: 37397057 PMCID: PMC10310443 DOI: 10.1055/s-0043-1763521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Ventriculoperitoneal (VP) shunts are a common neurosurgical procedure used to treat hydrocephalus. Despite their efficacy, many shunts fail and require revisions. The most common causes of shunt failure include obstruction, infection, migration, and perforation. Extraperitoneal migrations require urgent attention. We present a case of migration to the scrotum, a unique complication that may be present in young patients due to the presence of a patent processus vaginalis. Here, we discuss a case of a 16-month-old male patient with a VP shunt presenting with cerebrospinal fluid (CSF) drainage from his scrotum after an indirect hernia repair. This case represents an important reminder for physicians about the sequelae associated with VP shunt complications, particularly extraperitoneal migration, and brings awareness to the underlying factors that may increase this risk.
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Affiliation(s)
- Gregory Topp
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Pouya Entezami
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Shashikanth Ambati
- Department of Paediatrics, Albany Medical Center, Albany, New York, United States
| | - Benjamin Szewczyk
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Matthew A. Adamo
- Department of Neurosurgery, Albany Medical Center, Albany, New York, United States
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3
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Ndongo Sonfack DJ, Tarabay B, Shedid D, Yuh SJ. Unusual presentation of a common neurosurgical shunt procedure in an adult patient. SAGE Open Med Case Rep 2022; 10:2050313X221129770. [PMID: 36225226 PMCID: PMC9549185 DOI: 10.1177/2050313x221129770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Ventriculoperitoneal shunt surgery is one of the treatments of hydrocephalus. It involves placing a shunt from the cerebral ventricles to the peritoneum serving as a drainage point. Infection and catheter blockage are some of the possible complications resulting from this procedure. In some cases, other incidents such as peritoneal shunt migration have also been described. Here, we present the case of a 73-year-old male patient treated with ventriculoperitoneal shunt for a normal pressure hydrocephalus. After an initial blockage of the ventricular catheter, a revision surgery was performed with only mild improvement of his neurological symptoms. A repeat shunt series X-ray showed a migration of the distal catheter into the scrotum through an inguinal hernia. He was successfully treated with a laparoscopic repair of the inguinal hernia and repositioning of the distal catheter into the peritoneal cavity. Scrotal migration and hydrocele are unusual presentations and complications of ventriculoperitoneal shunts. Close follow-up of patients with a ventriculoperitoneal shunt should be performed if they experience worsening of their neurological symptoms. Shunt integrity should be assessed and any complications should be managed.
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Affiliation(s)
- Davaine Joel Ndongo Sonfack
- Faculty of Medicine, Laval University,
Québec, QC, Canada,Davaine Joel Ndongo Sonfack, Faculty of
Medicine, Laval University, Québec, QC, Canada.
| | - Bilal Tarabay
- Division of Neurosurgery, University of
Montreal, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Daniel Shedid
- Division of Neurosurgery, University of
Montreal, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Sung-Joo Yuh
- Division of Neurosurgery, University of
Montreal, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
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4
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Lou V, Yelorda K, Tung J. Ventriculoperitoneal shunt migration into an inguinal hernia with subsequent laparoscopic reduction and hernia repair. Trauma Surg Acute Care Open 2022; 7:e000951. [PMID: 35692610 PMCID: PMC9134172 DOI: 10.1136/tsaco-2022-000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Vivian Lou
- Stanford University School of Medicine, Stanford, California, USA
| | - Kirbi Yelorda
- Department of Surgery, Acute Care Surgery, Stanford Univeristy School of Medicine, Stanford, California, USA
| | - Jamie Tung
- Department of Surgery, Acute Care Surgery, Stanford Univeristy School of Medicine, Stanford, California, USA
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5
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Khoudir M, Harris L, Toescu SM, Vaqas B. Scrotal migration of a ventriculoperitoneal shunt in an adult. A case report and literature review. BRAIN AND SPINE 2022; 2:100898. [PMID: 36248102 PMCID: PMC9562235 DOI: 10.1016/j.bas.2022.100898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/20/2022] [Accepted: 06/02/2022] [Indexed: 11/28/2022]
Abstract
Introduction Scrotal migration of a ventriculoperitoneal shunt (VPS) catheter is a rare complication of VPS. Scrotal migrations usually manifest in the first year post-operatively, usually in the pediatric population, due to processus vaginalis patency and increased abdominal pressure. Research question To review cases of scrotal migration of a VPS catheter that occur in the adult population, and its recommended management. Material and methods A case report and review of the literature. Results A 75-year-old male with a ventriculoperitoneal shunt for normal pressure hydrocephalus, presented with testicular swelling. Imaging revealed that the distal shunt catheter had migrated into his scrotum. He required an emergency shunt revision, with a truncation of the catheter, and involvement of the general surgical team for hernia management. He remained well at one year follow-up. Discussion and conclusion To the best of our knowledge, this is the fifth case in an adult. This case serves as a reminder to take a thorough clinical history, imaging of the entire VPS pathway, and to consider unusual reasons for VPS failures. Emergency intervention for distal shunt revision is required to prevent further neurological or urological morbidity. Treatment includes not only catheter revision and reinsertion, but the catheter should be truncated, to avoid testicular migration recurrence. Hernia repair can be done either as an emergency or elective case, depending on the patient's clinical status and presentation. Ventriculoperitoneal catheter migration to the scrotum can occur in adults, as well as more commonly in paediatrics. This is the fifth adult case of scrotal distal cather shunt migration. This can cause a hydrocele and result in shunt failure. This can necessitate shunt revision and involvement of the general surgical team. In shunt failure, or scrotal swelling, thorough work-up must be done to diagnose rare, potentially fatal, conditions.
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6
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Migration of a Ventriculo-peritoneal Shunt into the Scrotum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Hauser T, Auer C, Ludwiczek J, Senker W, Rauch PR, Kargl S, Gruber A. Treatment Options for Scrotal Migration of Ventriculoperitoneal Shunts: Case Illustration and Systematic Review of 48 Cases. Oper Neurosurg (Hagerstown) 2021; 21:87-93. [PMID: 33989403 DOI: 10.1093/ons/opab152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Scrotal migration of intact or disconnected tubing is a rare complication of ventriculoperitoneal shunts. While some illustrative case reports can be found in the literature, a systematic review on treatment options is lacking. OBJECTIVE To propose the first literature-based treatment algorithm on scrotal shunt migration. METHODS We conducted a literature search using the keywords: "VP," "ventriculoperitoneal," "shunt," and "scrotum." We identified 36 publications with 48 cases reported including our index case. RESULTS Median age at presentation was 13.5 mo (3 d to 65 yr) which was 4 mo (3 d to 72 mo) after last shunt-related surgery. All patients had scrotal swelling, 39 (81%) patients presented without other symptoms, 4 (8%) had additionally local pain, and 4 (8%) patients presented with symptoms of shunt dysfunction. Treatment was surgically in all but one case where spontaneous resolution without repeat migration occurred. In 3 of 4 patients who had either subcutaneous shortening or abdominal repositioning of the shunt without hernia repair, scrotal shunt migration recurred within the following month. Whereas the surgical treatment with reposition of the migrated catheter back into the peritoneal cavity via a groin incision plus hernia repair yielded a definite treatment in all 26 performed cases, the revision rate was significantly higher in the shunt revision without hernia repair cohort (P = .0009). CONCLUSION Scrotal shunt migration is a rare shunt complication with good recovery when treated surgically. We recommend hernia repair in addition to either manual or surgical repositioning of migrated tubing.
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Affiliation(s)
- Thomas Hauser
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Christian Auer
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Johanna Ludwiczek
- Department of Pediatric Surgery, Kepler University Hospital, MedCampus 4, Linz, Austria
| | - Wolfgang Senker
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
| | - Philip-Rudolf Rauch
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria
| | - Simon Kargl
- Johannes Kepler University (JKU), Linz, Austria.,Department of Pediatric Surgery, Kepler University Hospital, MedCampus 4, Linz, Austria
| | - Andreas Gruber
- Department of Neurosurgery, Kepler University Hospital, Neuromedcampus, Linz, Austria.,Johannes Kepler University (JKU), Linz, Austria
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8
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Trang J, McHarg D, Owler B. Migration of distal ventriculoperitoneal shunt catheter into an inguinal hernia sac in an adult patient: a case report and literature review. ANZ J Surg 2021; 91:2538-2540. [PMID: 33710723 DOI: 10.1111/ans.16741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Jason Trang
- Department of Neurosurgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - David McHarg
- Department of Radiology and Nuclear Medicine, Sydney Adventist Hospital, Sydney, New South Wales, Australia
| | - Brian Owler
- Department of Neurosurgery, Sydney Adventist Hospital, Sydney, New South Wales, Australia.,Discipline of Child Health and Paediatrics, Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
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9
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Vilela Faquini I, Brandão Fonseca R, Batista Cezar Junior A, Corrêa de Albuquerque Leimig B, Just da Costa e Silva E, Santana Lima L, Barreto Machado Galvão L. Vaginal cerebrospinal fluid discharge due to fallopian tube perforation by distal catheter of ventriculoperitoneal shunt: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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10
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Soliman MAR, Ezzat AAM, Elwy R, Hasanain AA, Thabit MA, Elshitany H, Kandel H, Abdel-Bari SH, Ghoul AMF, Abdullah A, Alsawy MFM, Ghaleb AA, Menabbawy AA, Marei AA, El Razik BA, Marx S, Schroeder HWS, El Refaee E, Zohdi A. Letter to the Editor Regarding "Transoral Protrusion of a Ventriculoperitoneal Catheter Caused by Jejunal Perforation in an Adult: Rare Case Report and Review of the Literature". World Neurosurg 2020; 140:460. [PMID: 32797976 DOI: 10.1016/j.wneu.2020.05.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | - Reem Elwy
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Amr A Hasanain
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | | | - Haitham Kandel
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | | | - Ahmed Abdullah
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Ammar A Ghaleb
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Ahmed A Marei
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | - Sascha Marx
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt; Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Ahmed Zohdi
- Department of Neurosurgery, Cairo University, Cairo, Egypt
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11
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Chan AC, Woo PY, Au Y, Chan K, Wong H. Scrotal migration of a ventriculoperitoneal shunt. SURGICAL PRACTICE 2019. [DOI: 10.1111/1744-1633.12367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Yiu‐Kai Au
- NeurosurgeryKwong Wah Hospital Hong Kong
| | - Kwong‐Yau Chan
- Department of General SurgeryKwong Wah Hospital Hong Kong
| | - Hoi‐Tung Wong
- Department of General SurgeryKwong Wah Hospital Hong Kong
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12
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Deora H, Sharma A, Rao KVLN, Somanna S, V V. Needle in a haystack: migration of ventriculoperitoneal shunt into scrotum of infant. EGYPTIAN JOURNAL OF NEUROSURGERY 2018. [DOI: 10.1186/s41984-018-0001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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13
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Nawaz A, Chaudhry MBH, Mirza WA. Cerebrospinal fluid hydrocele caused by scrotal migration of a ventriculoperitoneal shunt. BMJ Case Rep 2018; 2018:bcr-2018-224698. [PMID: 30317190 DOI: 10.1136/bcr-2018-224698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 6-month-old boy presented with painless right hemiscrotal swelling. The scrotal ultrasound revealed a cerebrospinal fluid hydrocele caused by the migration of a ventriculoperitoneal shunt (VPS) catheter tip into the right hemiscrotum and associated undescended left testis. Earlier, he underwent a VPS placement for hydrocephalus secondary to neonatal bacterial meningitis and ventriculitis. The patient was treated with bilateral herniotomy, left-sided orchidopexy and repositioning of VPS into the peritoneal cavity.
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Affiliation(s)
- Atif Nawaz
- Department of Radiology, Aga Khan University, Karachi, Sindh, Pakistan
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14
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Migration of the Distal Catheter of Ventriculoperitoneal Shunts in Pediatric Age Group: Case Series. World Neurosurg 2018; 119:e131-e137. [PMID: 30031953 DOI: 10.1016/j.wneu.2018.07.073] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation. METHODS Between 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified. RESULTS Of 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions. CONCLUSIONS Peritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases.
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15
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Hori YS, Nagakita K, Ebisudani Y, Aoi M, Shinno Y, Fukuhara T. Choroid Plexus Hyperplasia with Intractable Ascites and a Resulting Communicating Hydrocele following Shunt Operation for Hydrocephalus. Pediatr Neurosurg 2018; 53:407-412. [PMID: 30157489 DOI: 10.1159/000492333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/22/2018] [Indexed: 11/19/2022]
Abstract
Choroid plexus hyperplasia/papilloma and resulting hyperproduction of cerebrospinal fluid is a rare cause of hydrocephalus. In these patients, intractable ascites can occur after a ventriculoperitoneal (VP) shunting operation. However, shunt-related hydrocele is a rare complication of VP shunting. Previous reports have indicated catheter-tip migration to the scrotum as a cause of hydrocele. Here, we present the first documented case of choroid plexus hyperplasia that led to intractable ascites after shunting and a resulting hydrocele without catheter-tip migration into the scrotum.
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Affiliation(s)
- Yusuke S Hori
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama,
| | - Keina Nagakita
- Department of Pathology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yuki Ebisudani
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Mizuho Aoi
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yoko Shinno
- Department of Pathology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Toru Fukuhara
- Department of Neurological Surgery, National Hospital Organization Okayama Medical Center, Okayama, Japan
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16
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Foster M, Wilson G, Jenkinson MD, Buxton N. A rare case of ventriculoperitoneal shunt malfunction due to scrotal migration of the peritoneal catheter. Br J Neurosurg 2017; 33:566-567. [DOI: 10.1080/02688697.2017.1378802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mitchell Foster
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Graeme Wilson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D. Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Neil Buxton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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17
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Fernandez-Ibieta M, Villamil V, Martinez-Lage J. Migration of a ventriculoperitoneal shunt catheter through the processus vaginalis in infants: how serious inguinal hernia and hydrocele might be. Acta Neurochir (Wien) 2017; 159:1417-1419. [PMID: 28616670 DOI: 10.1007/s00701-017-3243-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 05/31/2017] [Indexed: 11/28/2022]
Abstract
Migration of the catheter tip of a ventriculoperitoneal shunt (VPS) through a patent processus vaginalis (PV) has seldom being reported. In this series, we analyzed all cases of inguinoscrotal migration of an VPS catheter at our center. Between 1975 and 2015, 295 VPS insertions were performed. In seven infants (2.3%), migration of the catheter through a patent PV was demonstrated. Cases with hydroceles had associated VPS malfunction, but cases with hernias were not associated with it. The current recommendation is to delay a PV closure until 2 years of age in cases of infants with hydrocele without further radiological examinations, but this might not be the case in infants with VPS.
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Affiliation(s)
- Maria Fernandez-Ibieta
- Pediatric Surgery Department, Hospital CUV Arrixaca, Crta El palmar s/n, 30012, Murcia, Spain.
| | - Vanesa Villamil
- Pediatric Surgery Department, Hospital CUV Arrixaca, Crta El palmar s/n, 30012, Murcia, Spain
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18
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Allouh MZ, Al Barbarawi MM, Asfour HA, Said RS. Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective. Clin Anat 2017. [PMID: 28622424 DOI: 10.1002/ca.22928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
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.
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Affiliation(s)
- Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Mohammed M Al Barbarawi
- Division of Neurosurgery, Department of Neurosciences, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Hasan A Asfour
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Raed S Said
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
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19
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Ricci C, Velimirovic BM, Fitzgerald TN. Case report of migration of 2 ventriculoperitoneal shunt catheters to the scrotum: Use of an inguinal incision for retrieval, diagnostic laparoscopy and hernia repair. Int J Surg Case Rep 2016; 29:219-222. [PMID: 27883967 PMCID: PMC5122702 DOI: 10.1016/j.ijscr.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022] Open
Abstract
A ventriculoperitoneal shunt catheter migrated through an inguinal hernia into the scrotum. A single incision was used to for diagnostic laparoscopy, catheter removal and hernia repair. Prompt surgical removal of fractured shunt catheters is recommended to prevent organ injury.
Backgroud Ventriculoperitoneal shunts are commonly used in the treatment of hydrocephalus, and catheter migration to various body sites has been reported. Pediatric and general surgeons are asked on occasion to assist with intraabdominal access for these shunts, particularly when there may be extensive adhesions or other complicating factors. Methods We describe a case in which an old shunt catheter was never removed from the abdomen, and it migrated through an inguinal hernia into the scrotum. The catheter became entangled and fibrosed to the testicle. A second and more recent shunt catheter was also in the scrotum. A single incision in the inguinal region was used to remove both shunt catheters, repair the inguinal hernia and perform diagnostic laparoscopy to assist in placing a new ventriculoperitoneal shunt. Results Prompt surgical removal is recommended for catheters remaining in the abdomen after ventriculoperitoneal shunt malfunction. These catheters may cause injury to the testicle, or possibly other intraabdominal organs. General or pediatric surgical consultation should be obtained for lost catheters or inguinal hernias. Conclusion In the case of an inguinal hernia containing a fractured shunt catheter, the hernia sac can be used to remove the catheter, repair the hernia and gain laparoscopic access to the abdomen to assist with shunt placement.
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Affiliation(s)
- Caesar Ricci
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA
| | | | - Tamara N Fitzgerald
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA.
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Singh S, Pant N, Kumar P, Pandey A, Khan TR, Gupta A, Rawat J. Migration of Ventriculoperitoneal Shunt into a Hernia Sac: An Unusual Complication of Ventriculoperitoneal Shunt Surgery in Children. Pediatr Neurosurg 2016; 51:154-7. [PMID: 26872356 DOI: 10.1159/000442179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023]
Abstract
We report 2 cases of ventriculoperitoneal (VP) shunt migration into an inguinal hernia sac. In both cases hernia manifested itself on the right side in late infancy. We attempted to analyse the anatomical and mechanical factors leading to shunt migration as seen in the X-rays of our cases.
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Affiliation(s)
- Sudhir Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, India
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