1
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Kashyap S, Singh SK, Gupta G. Scrotal migration of a ventriculoperitoneal shunt. BMJ Case Rep 2024; 17:e260380. [PMID: 39074949 DOI: 10.1136/bcr-2024-260380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Abstract
Ventriculoperitoneal shunt (VPS) is the most common procedure done for hydrocephalus in the paediatric population. While shunt infection and shunt malfunction remain the most common complications, shunt migration is not frequently observed. Being present in a large peritoneal cavity, theoretically, a shunt can travel to a variety of locations. Even among these, scrotal migration is quite uncommon. This case highlights the significance of keeping this possibility in mind while evaluating a case of shunt malfunction. It also discusses various nuances of surgically managing scrotal migration.
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Affiliation(s)
- Shalvika Kashyap
- Paediatric Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Santosh Kumar Singh
- Paediatric Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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2
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Awwad AR, S H Odeh M, Asad D, Y M H Abu Rmeileh B, M M Dweik A, N M Baraka S, A F Karami M, I M Awad I, W M Jobran A. Ventriculoperitoneal Shunt Migration Into the Transverse Colon: A Case Report. Cureus 2024; 16:e52334. [PMID: 38361682 PMCID: PMC10867295 DOI: 10.7759/cureus.52334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
A ventriculoperitoneal (VP) shunt is a connection between the cerebral ventricles and the peritoneal cavity. One of the rare complications of this procedure is shunt migration and perforation of the bowel. Our case report presents the case of a 19-month-old male patient who underwent VP shunt insertion due to hydrocephalus at the age of 8 months. He suffered from two episodes of bacterial meningitis at the ages of 11 and 15 months, requiring hospital admission. The patient's parents brought him to the emergency department after noticing a blood-stained diaper and seeing a part of the shunt extruding from the anal opening. Upon physical examination, the patient was active, neither in distress nor tachycardic. with unremarkable abdominal examination and negative peritoneal signs. A digital rectal examination showed normal anal tone, with normal-coloured stool with no blood at the tip of the finger, together with a compressible VP shunt. Complications of this type of migration include faecal contamination and possible infections such as ascending meningitis. This case report highlights the extrusion of the shunt through the anal orifice in a 19-month-old male patient which serves as an example of the uncommon but serious consequence of VP shunt insertion in the pediatric population. While VP shunt insertion remains a widely used and effective treatment for hydrocephalus, healthcare providers need to recognize and address potential complications associated with this procedure. Additionally, this case emphasizes the importance of diligent monitoring and regular radiographic imaging to confirm the correct positioning of shunt components, particularly in the paediatric population.
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Affiliation(s)
- Ahmad R Awwad
- General Practice, Rafidia Governmental Hospital, Nablus, PSE
| | - Manar S H Odeh
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Diya Asad
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | | | - Aya M M Dweik
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Saja N M Baraka
- Medicine, Faculty of Medicine, Al Quds-University, Jerusalem, PSE
| | - Malek A F Karami
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Iyas I M Awad
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Afnan W M Jobran
- Medicine, Faculty of Medicine, Al-Quds University, Jerusalem, PSE
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3
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Ghritlaharey RK. Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis. World J Clin Pediatr 2023; 12:331-349. [PMID: 38178931 PMCID: PMC10762601 DOI: 10.5409/wjcp.v12.i5.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/04/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt (VPS) catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion. AIM To identify the demographics, clinical presentation, clinical findings, and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter, clinically presented with or without trans-oral extrusion. METHODS An online search was performed for the extraction/retrieval of the published/ available literature pertaining to the above-mentioned VPS complication. Manuscripts were searched from PubMed, PMC (PubMed Central), ResearchGate, and Google Scholar databases using various terminology relating to the VPS complications. The first case of migration of a VPS catheter into the stomach was reported in the year 1980, and the data were retrieved from 1980 to December 2022. Cases were categorized into two groups; Group A: Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same, and Group B: Cases who had migration of the distal VPS catheter into the stomach, but presented without trans-oral extrusion. RESULTS A total of n = 46 cases (n = 27; 58.69% male, and n = 19; 41.3% females) were recruited for the systematic review. Group A included n = 32, and Group B n = 14 cases. Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the (n = 22) cases. Approximately sixty percent (n = 27) of them were children ≤ 5 years of age at the time of the diagnosis of the complication mentioned above. In seventy-two percent (n = 33) cases, this complication was detected within 24 mo after the VPS insertion/last shunt revision. Clinical diagnosis was evident for the entire group A cases. Various diagnostic modalities were used to confirm the diagnosis for Group B cases. Various surgical procedures were offered for the management of the complication in n = 43 cases of both Groups. In two instances, intra-gastric migration of the distal VPS catheter was detected during the autopsy. This review documented four deaths. CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups. It was more frequently reported in children, although also reported in adults and older people. A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without trans-oral extrusion.
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Affiliation(s)
- Rajendra Kumar Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal 462001, Madhya Pradesh, India
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4
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Refaee EE, Alsawy MF, Abdullah A, Weidemeier M, Menabbawy AA, Elwy R, Zohdi A, Schroeder HWS. Neurosurgical Summer Course for Overseas Students: A Step toward Better Dialogue with the Future Working Teams. J Neurol Surg A Cent Eur Neurosurg 2023; 84:610-612. [PMID: 37023790 DOI: 10.1055/a-2070-4875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Ehab El Refaee
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Mohamed F Alsawy
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Abdullah
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Martin Weidemeier
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Ahmed Al Menabbawy
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Reem Elwy
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Zohdi
- Department of Neurosurgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Henry W S Schroeder
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
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5
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Scarascia A, Atallah E, Pineda MDA, Rosenwasser R, Judy K. Gastric perforation from a migrating ventriculoperitoneal shunt: A case report and review of literature. Radiol Case Rep 2022; 17:4899-4902. [PMID: 36281285 PMCID: PMC9587122 DOI: 10.1016/j.radcr.2022.09.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/18/2022] [Indexed: 11/01/2022] Open
Abstract
Ventriculoperitoneal (VP) shunts represent a surgical option for patients affected by increased intracranial hypertension when medical management fails or is contraindicated. Complications following implantation include shunt obstruction, infection, over and under drainage, migration or disconnection of the tube, formation of a pseudocyst, and allergy to the silicone tube. We report the case of a 31-year-old woman who presented to the emergency room with nausea and generalized malaise, found to have the distal segment of the VP catheter perforating her gastric wall into the stomach lumen which required surgical intervention. In this report, we describe a rare complication associated with the implantation of ventriculoperitoneal shunt (VPS) catheters and the subsequent management plan.
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Affiliation(s)
- Alessio Scarascia
- Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168 Rome RM, Italy,Corresponding author.
| | - Elias Atallah
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
| | | | - Robert Rosenwasser
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
| | - Kevin Judy
- Thomas Jefferson University, 1020 Walnut St, Philadelphia, PA 19107, USA
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6
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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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7
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Ambati SR, Barry S, Matthew AA, Edwards M. Transvaginal Migration of Ventriculoperitoneal Shunts in Children: Review of Literature. Asian J Neurosurg 2022; 17:399-406. [PMID: 36398177 PMCID: PMC9665996 DOI: 10.1055/s-0042-1757218] [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] [Indexed: 11/17/2022] Open
Abstract
Ventriculo-peritoneal shunt placement is the most commonly performed procedure for the treatment of hydrocephalus. The complication of migration of the distal ventriculo-peritoneal shunt is one of the many complications that occur after ventriculo-peritoneal shunt placement. The migration of the ventriculo-peritoneal shunt through the vagina is infrequently reported in children. The aim of this review is to help all the providers caring for children with ventriculo-peritoneal shunts to identify issues early when encountered with this complication and thus limit morbidity and mortality. We reviewed all cases of migration of ventriculo-peritoneal shunt through the vagina in children less than 18 years of age that were published in the literature using PubMed, Google Scholar, Web of Science, and Cochrane Library. A total of 11 articles met the eligibility criteria and were included in this review among the 93 articles obtained with title and abstract screening. Previous non-shunt-related abdominal operations and shunt revisions are consistent risk factors in all cases. We did not recognize specific approaches to catheter placement or management that could have prevented this complication. Ventriculitis necessitating shunt removal and therapies requiring additional procedures and prolonged hospitalization are the major consequences identified. Awareness of this unusual complication is very important among health care providers such as emergency care health providers who are likely to be the first to encounter these children on initial presentation.
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Affiliation(s)
- Shashikanth R Ambati
- Department of Pediatric Critical Care, Albany Medical Center, Albany, New York, United States,Address for correspondence Shashikanth Ambati, MBBS Pediatric Critical Care, Albany Medical Center43 New Scotland Ave, A422, Albany, NY 12208United States
| | - Suzanne Barry
- Department of Pediatric Critical Care, Albany Medical Center, Albany, New York, United States
| | - Adamo A Matthew
- Department of Pediatric Neurosurgery, Albany Medical Center, Albany, New York, United States
| | - Mary Edwards
- Department of Pediatric Surgery, Albany Medical Center, Albany, New York, United States
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8
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Şahin MH, Temtek U. Enterococcus gallinarum group meningitis after transanal migration of the ventriculoperitoneal shunt: a pediatric case report. Childs Nerv Syst 2022; 39:1093-1096. [PMID: 36153363 DOI: 10.1007/s00381-022-05683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022]
Abstract
In the literature, only 11 Enterococcus gallinarum group meningitis has been reported so far. The Enterococcus gallinarum group was shown for the first time in a pediatric patient presenting with meningitis after bowel perforation, a complication of a ventriculoperitoneal shunt. A 30-month-old male patient presented with vomiting and fever, with the ventriculoperitoneal shunt distal catheter protruding from the anal orifice. The patient was diagnosed with intestinal perforation and meningitis. Enterococcus gallinarum group bacterial yield in cerebrospinal fluid culture. A total of 6 weeks of intravenous antibiotic treatment was given in the hospital. After the treatment, the patient was re-ventriculoperitoneal shunt and was discharged. Among the shunt complications, meningitis with intestinal perforation is rare. It should be kept in mind that meningitis in such patients may be caused by very rare microbiological factors such as Enterococcus gallinarum group. Antibiotherapy should be given according to the culture result. Then planning should be made for a permanent shunt.
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Affiliation(s)
- Mehmet Hakan Şahin
- Neurosurgery Department, Faculty of Medicine, Ataturk University, Erzurum, Turkey.
| | - Ufuk Temtek
- Neurosurgery Department, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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9
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Hasanain AA, Soliman MAR, Elwy R, Ezzat AAM, Abdel-Bari SH, Marx S, Jenkins A, El Refaee E, Zohdi A. An eye on the future for defeating hydrocephalus, ciliary dyskinesia-related hydrocephalus: review article. Br J Neurosurg 2022; 36:329-339. [PMID: 35579079 DOI: 10.1080/02688697.2022.2074373] [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: 11/02/2022]
Abstract
Congenital hydrocephalus affects approximately one in 1000 newborn children and is fatal in approximately 50% of untreated cases. The currently known management protocols usually necessitate multiple interventions and long-term use of healthcare resources due to a relatively high incidence of complications, and many of them mostly provide a treatment of the effect rather than the cause of cerebrospinal fluid flow reduction or outflow obstruction. Future studies discussing etiology specific hydrocephalus alternative treatments are needed. We systematically reviewed the available literature on the effect of ciliary abnormality on congenital hydrocephalus pathogenesis, to open a discussion on the feasibility of factoring ciliary abnormality in future research on hydrocephalus treatment modalities. Although there are different forms of ciliopathies, we focused in this review on primary ciliary dyskinesia. There is growing evidence of association of other ciliary syndromes and hydrocephalus, such as the reduced generation of multiple motile cilia, which is distinct from primary ciliary dyskinesia. Data for this review were identified by searching PubMed using the search terms 'hydrocephalus,' 'Kartagener syndrome,' 'primary ciliary dyskinesia,' and 'immotile cilia syndrome.' Only articles published in English and reporting human patients were included. Seven studies met our inclusion criteria, reporting 12 cases of hydrocephalus associated with primary ciliary dyskinesia. The patients had variable clinical presentations, genetic backgrounds, and ciliary defects. The ependymal water propelling cilia differ in structure and function from the mucus propelling cilia, and there is a possibility of isolated non-syndromic ependymal ciliopathy causing only hydrocephalus with growing evidence in the literature for the association ependymal ciliary abnormality and hydrocephalus. Abdominal and thoracic situs in children with hydrocephalus can be evaluated, and secondary damage of ependymal cilia causing hydrocephalus in cases with generalized ciliary abnormality can be considered.
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Affiliation(s)
| | - Mohamed A R Soliman
- Department of Neurosurgery, Cairo University, Cairo, Egypt.,Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences at University at Buffalo, Buffalo, New York, USA
| | - Reem Elwy
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | | | | | - Sascha Marx
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - Alistair Jenkins
- Department of Neurosurgery Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom
| | - 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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10
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Fernandez B, Gautier A, Koumaré IB, Fabre JM, Coubes P, Poulen G. Transcutaneous ventriculo-peritoneal shunt catheter extrusion with silent bowel perforation following digestive surgery: a case report. Br J Neurosurg 2022:1-4. [PMID: 35174740 DOI: 10.1080/02688697.2022.2039373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/28/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022]
Abstract
This case report provides an account of transcutaneous ventriculo-peritoneal (VP) shunt extrusion with silent bowel perforation occurring 2 years post digestive surgery. A 22-year-old man treated since childhood for post-infectious hydrocephalus was referred to our neurosurgery department for an inflammatory wound to the right hypochondrium caused by an abandoned calcified VP shunt. This VP shunt was surgically removed without complications. The perforated bowel required no direct repair. Progress is favorable at 1 year follow-up.
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Affiliation(s)
- Benjamin Fernandez
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, Haut-Lévêque Hospital, CHU Bordeaux, France
| | | | - Izoudine B Koumaré
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
| | | | - Philippe Coubes
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
- Institut de Génomique Fonctionnelle, Montpellier, France
- CNRS UMR5203, Montpellier, France
- INSERM U661, Montpellier, France
| | - Gaëtan Poulen
- Unité "Pathologies cérébrales résistantes", Department of Neurosurgery, CHU Gui De Chauliac, Montpellier, France
- Unité de Recherche sur les Comportements et mouvements anormaux, CHU Montpellier, France
- Institut de Génomique Fonctionnelle, Montpellier, France
- CNRS UMR5203, Montpellier, France
- INSERM U661, Montpellier, France
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11
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Ghritlaharey R. Systematic literature review of the management of transanal extrusion of distal ventriculoperitoneal shunt catheter: 1966–2020. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_149_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Kim E. The Shunt Slippage: A Complication of Pumping Test. Korean J Neurotrauma 2022; 18:110-115. [PMID: 35557644 PMCID: PMC9064754 DOI: 10.13004/kjnt.2022.18.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/09/2021] [Accepted: 01/10/2022] [Indexed: 11/16/2022] Open
Abstract
Surgery for the placement of a ventriculoperitoneal shunt incurs numerous procedure-related complications. Distal dislodgment of the device from the cranial insertion site after pumping of the shunt chamber has rarely occurred and it has not been evaluated to date. Herein, we report an interesting case of a 20-year-old man who underwent shunt revision for ventricular catheter migration after a manual pumping test. We reviewed previously reported cases related to such rare conditions and described a simple method of valve fixation for preventing disconnection and migration of the proximal shunt system.
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Affiliation(s)
- El Kim
- Department of Neurosurgery, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
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13
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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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14
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Faber H, Ernemann U, Sachs H, Gekeler F, Danz S, Koitschev A, Besch D, Bartz-Schmidt KU, Zrenner E, Stingl K, Kernstock C. CT Assessment of Intraorbital Cable Movement of Electronic Subretinal Prosthesis in Three Different Surgical Approaches. Transl Vis Sci Technol 2021; 10:16. [PMID: 34264295 PMCID: PMC8299430 DOI: 10.1167/tvst.10.8.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose Electronic retinal implants restore some visual perception in patients blind from retinitis pigmentosa. Eye movements cause mechanical stress in intraorbital power supply cables leading to cable breaks. By using computer tomography (CT) scans at the extreme positions of the four cardinal gaze directions, this study determined in vivo, which of three surgical routing techniques results in minimal bending radius variation and favors durability. Methods Nine patients received the first-generation subretinal implant Alpha IMS (Retina Implant AG, Reutlingen, Germany) in one eye. Three techniques for intraorbital cable routing were used (straight cable route (A), parabulbar loop (B), and encircling band (C)), each in three patients. All patients underwent computer tomography of the orbital region. The bending radius of the intraorbital cable was measured with the DICOM viewer Osirix v4.1.2 (Pixmeo SARL, Bernex, Switzerland) and served as indicator for mechanical stress. Results Average bending radius variation was 87% for method A, 11% for method B, and 16% for method C. Methods A and B (P = 0.005) and methods A and C (P = 0.007) differed significantly, while method B and C showed no statistical difference (P = 0.07). Conclusions Compared to straight routes, arcuated cable routes significantly reduce cable movement and bending. Due to an easier surgical procedure, a parabulbar loop is the preferred method to minimize bending radius variation and prolong survival time of electronic subretinal implants. Translational Relevance CT analysis of cable bending of implanted medical devices allows to determine which surgical routing technique favors durability in vivo.
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Affiliation(s)
- Hanna Faber
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, Radiological Clinic, University of Tuebingen, Tuebingen, Germany
| | - Helmut Sachs
- Ophthalmology Clinic, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Germany
| | - Florian Gekeler
- Ophthalmology Clinic, Klinikum Stuttgart, Stuttgart, Germany
| | - Søren Danz
- Radiologische Praxis Hofbauer Danz Fischer, Sindelfingen, Germany
| | - Assen Koitschev
- Clinic for Ear, Nose and Throat Disorders, Plastic Surgery, Klinikum Stuttgart, Stuttgart, Germany
| | - Dorothea Besch
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
| | | | - Eberhart Zrenner
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Institute for Ophthalmic Research, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Werner Reichardt Centre for Integrative Neuroscience, University of Tuebingen, Tuebingen, Germany
| | - Katarina Stingl
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany.,Center of Rare Eye Diseases, University of Tuebingen, Tuebingen, Germany
| | - Christoph Kernstock
- University Eye Hospital, Center for Ophthalmology, University of Tuebingen, Tuebingen, Germany
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15
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El Refaee E, Zohdi A, Schroeder HWS. Letter: A New Trend of Blended Learning in Neurosurgical Training: Fellowship of Neuroendoscopy. Neurosurgery 2021; 89:E89-E90. [PMID: 33913500 DOI: 10.1093/neuros/nyab134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/17/2021] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ehab El Refaee
- Department of Neurosurgery Cairo University Giza, Egypt.,Department of Neurosurgery University Medicine Greifswald Greifswald, Germany
| | - Ahmed Zohdi
- Department of Neurosurgery Cairo University Giza, Egypt
| | - Henry W S Schroeder
- Department of Neurosurgery University Medicine Greifswald Greifswald, Germany
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16
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Sinha VD, Bhardwaj S, Purohit D, Chopra S. Unusual extrusion of distal end of ventriculoperitoneal shunt: Case series with literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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17
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Pseudocyst in Neck: A Case Report on Rare Complication of Ventriculoperitoneal Shunt. Case Rep Otolaryngol 2021; 2021:6656506. [PMID: 34007501 PMCID: PMC8110417 DOI: 10.1155/2021/6656506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/01/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Ventriculoperitoneal shunt is a common neurosurgical procedure, for the definitive management of hydrocephalus. Shunt failures may occur due to various causes but are usually due to infections in adults and catheter occlusion in the paediatric population. Case Report. The 13-year-old girl presented with a right lateral neck swelling. In detailed history, she was found to be an old case of ventriculoperitoneal shunt. The clinical examination and radiological investigation revealed proximal dislodgment of the stent from the cranium, causing persistent cerebrospinal fluid (CSF) leak and pseudocyst formation in the neck. Conclusion The case highlights CSF pseudocyst formation as a rare differential for lateral neck swellings.
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18
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Chen YA, Hsieh CT, Sun JM. Extrahepatic pseudocyst in an adult. ACTA ACUST UNITED AC 2021; 26:97-102. [PMID: 33530051 PMCID: PMC8015490 DOI: 10.17712/nsj.2021.1.20200117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/30/2020] [Indexed: 11/20/2022]
Abstract
Ventriculoperitoneal (VP) shunts are commonly used in neurosurgical procedures to treat hydrocephalus. Although shunt-associated abdominal complications are well documented, extrahepatic pseudocysts are a rare shunt complication in adult patients. Therefore, we herein report the case of a 54-year-old male patient who presented with a bulging mass around the previous surgical site at the right upper quadrant of the abdomen. He had a 4-year history of VP shunt surgery for posthemorrhagic hydrocephalus. A computed tomographic scan revealed a large extrahepatic pseudocsyt. Our case represented a rare entity of extrahepatic pseudocyst in adult patients underwent VP shunt surgery. The clinical presentation, diagnostic tools, and treatment methods were discussed.
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Affiliation(s)
- Yi-An Chen
- From the Department of Neurological Surgery (Chen), Tri-Service General Hospital, National Defense Medical Center, from the Department of Medicine (Hsieh), School of Medicine, Fu Jen Catholic University, Taipei, from the Division of Neurosurgery (Hsieh), Department of Surgery, Sijhih Cathay General Hospital, from the Department of Medicine (Hsieh), School of Medicine, Fu Jen Catholic University, New Taipei, from the Section of Neurosurgery (Sun), Department of Surgery, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, and the Department of Biotechnology (Sun), Asia University, Taichung, Taiwan
| | - Cheng-Ta Hsieh
- From the Department of Neurological Surgery (Chen), Tri-Service General Hospital, National Defense Medical Center, from the Department of Medicine (Hsieh), School of Medicine, Fu Jen Catholic University, Taipei, from the Division of Neurosurgery (Hsieh), Department of Surgery, Sijhih Cathay General Hospital, from the Department of Medicine (Hsieh), School of Medicine, Fu Jen Catholic University, New Taipei, from the Section of Neurosurgery (Sun), Department of Surgery, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, and the Department of Biotechnology (Sun), Asia University, Taichung, Taiwan
| | - Jui-Ming Sun
- From the Department of Neurological Surgery (Chen), Tri-Service General Hospital, National Defense Medical Center, from the Department of Medicine (Hsieh), School of Medicine, Fu Jen Catholic University, Taipei, from the Division of Neurosurgery (Hsieh), Department of Surgery, Sijhih Cathay General Hospital, from the Department of Medicine (Hsieh), School of Medicine, Fu Jen Catholic University, New Taipei, from the Section of Neurosurgery (Sun), Department of Surgery, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, and the Department of Biotechnology (Sun), Asia University, Taichung, Taiwan
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19
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Alhendawy I, Dhaliwal T, Siedler DG, Homapour B. Early postoperative colonic ventriculoperitoneal shunt migration with trans-anal protrusion: A unique case report. Int J Surg Case Rep 2021; 81:105796. [PMID: 33770638 PMCID: PMC7994786 DOI: 10.1016/j.ijscr.2021.105796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 01/17/2023] Open
Abstract
Early post-operative trans-anal shunt protrusion is a rare presentation. Patients may be asymptomatic. With concomitant bowel surgery, it may indicate intraoperative occult bowel injury. Early post-operative follow up shunt imaging is recommended in this group.
Introduction and importance Colonic ventriculoperitoneal shunt (VPS) migration with trans-anal protrusion remains uncommon. Patients may be asymptomatic, and diagnosis may only be made on visualization of the prolapsed catheter from the anus. This unique case of early post-operative trans-anal shunt protrusion highlight the possibility of this rare complication specially when shunt revision accompanies bowel surgery. Case presentation The authors present a case of early postoperative colonic shunt migration in a thirteen-year-old female with who underwent Malone Antegrade Continence Enema (MACE) with concomitant revision of the distal part of the peritoneal catheter. She presented two weeks post operatively with shunt catheter protruding from the anus. This was noticed by her carer and she was asymptomatic on her presentation. Clinical discussion Delayed post-operative shunt related bowel perforation and trans-anal shunt protrusion is an uncommon complication after ventriculoperitoneal shunting. Most cases present months after surgery and majority are asymptomatic on presentation. The exact pathophysiology is not established, and mechanisms have been proposed. Early post -operative trans-anal shunt protrusion is rare and suggests inadvertent occult bowel injury especially when shunt placement or revision accompanies extensive bowel surgery. Conclusion The authors recommended shunt imaging within the first two to three weeks after shunt revision in patient who undergo concomitant bowel surgery with risk of inadvertent bowel injury to identify early colonic migration and avoid its potentially fatal sequelae.
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Affiliation(s)
- Ibrahem Alhendawy
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
| | - Tarundeep Dhaliwal
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
| | - Declan G Siedler
- Department of Neurosurgery, Alfred Hospital, Melbourne, Victoria, 3004, Australia.
| | - Bob Homapour
- Department of Neurosurgery, Monash Medical Centre, Clayton, Victoria, 3168, Australia.
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20
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Ezzat AAM, Soliman MAR, Baraka M, Shimy ME, Ezz A, Refaee EE. Distant large acute epidural hematoma after closed cerebrospinal fluid tapping through the anterior fontanelle: A case report and its pathogenesis. Surg Neurol Int 2021; 12:59. [PMID: 33654562 PMCID: PMC7911216 DOI: 10.25259/sni_921_2020] [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: 12/16/2020] [Accepted: 01/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Cerebrospinal fluid (CSF) infection is one of the most common and serious complications of shunt placement. The CSF shunt infections are preferably treated with intravenous antibiotics, infected shunt removal, repeated tapping (infants) or placement of an external ventricular drainage (EVD) device, and placement of a new shunt once the CSF is sterile. The tapping through the anterior fontanelle is commonly used instead of the EVD in developing countries to manage CSF infection in open anterior fontanelle patients. To the best of our knowledge, this would be considered the first reported case of distant epidural hematoma after closed ventricular tapping. Case Description: We report a case of 6-months child with Chiari malformation (Type II) presenting to us with a shunt infection with possible obstruction. CSF was aspirated for examination through a tap through the anterior fontanelle followed by the development of extradural hemorrhage far from the tapping site. Conclusion: EDH after a transfontanellar ventricular tap can rapidly evolve and lead to patient death. This report raises the awareness of the neurosurgeons to this possible complication that can happen and leads to major complications. Monitoring the conscious level would be needed after ventricular tapping to detect this possible complication.
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Affiliation(s)
| | | | | | | | - Adham Ezz
- Department of Neurosurgery, Cairo University, Cairo, Egypt
| | - Ehab El Refaee
- Department of Neurosurgery, Cairo University, Cairo, Egypt
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21
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Hidayat I, Syahputra DA, Isa MM. Unusual migration of distal ventriculoperitoneal shunt to Vagina via fallopian tube: A case report. Ann Med Surg (Lond) 2021; 63:102158. [PMID: 33659058 PMCID: PMC7890132 DOI: 10.1016/j.amsu.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction and Importance: Ventriculoperitoneal shunt (VPS) is the most common procedure performed on children with hydrocephalus. Migration of VPS outside the peritoneal cavity is rare, especially fallopian tube migration with vaginal extrusion without organ perforation. Presentation of Case: A 3-year-old girl came to the hospital with the main complaint of having a white tube exposed from her vagina 4 days before admission. A history of frequent clear watery discharge from the vagina since one week before the admission alongside intermittent pain in the suprapubic area was obtained from the parents. A laparotomy was conducted on the patient. We found the distal shunt catheter had adhered to the omentum and it appeared that the catheter tube entered the right fallopian tube before it went into the uterus and out to the vagina. We replaced the distal catheter with a new one. The patient came home on the fourth day of the post-surgery in a good condition. Clinical Discussion: The etiology of distal shunt catheter migration into the vagina remains unclear. Our patient is the third documented case of fallopian tube migration with vaginal extrusion without organ perforation, suspected due to postsurgical adhesions to the fallopian tube. An evaluation of vaginal discharge associated with abdominal pain is an important clue for distal migration of the VPS to the vagina. Conclusion: The migration of catheter to the vagina should be considered of profuse watery discharge from vagina alongside intermittent abdominal colicky pain. The surgical goal is to re-establish a new VP shunt system. Ventriculoperitoneal shunt (VPS) is the common procedure performed on hydrocephalus. Migration of VPS to vaginal through fallopian tube is extremely rare. The etiology possibility formation of fibrosis around the tube to the adjacent organ. Vaginal discharge associated abdominal pain is an important clue for VPS migration. The surgical goal is to reestablish a new VP shunt system.
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Affiliation(s)
- Imam Hidayat
- Neurosurgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
| | - Dian Adi Syahputra
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
| | - Muntadhar Muhammad Isa
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Syiah Kuala University/Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
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22
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In Reply to the 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; 140:461. [PMID: 32797977 DOI: 10.1016/j.wneu.2020.05.202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022]
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23
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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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Chen YH, Hsieh CT, Sun JM, Chang SI. Gastric perforation by a ventriculoperitoneal shunt in an adult. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2020; 25:144-147. [PMID: 32351252 PMCID: PMC8015529 DOI: 10.17712/nsj.2020.2.20190118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ventriculoperitoneal (VP) shunt operation is a common neurosurgical procedure applied for managing intracranial hydrocephalus. Migration of a distal catheter is an uncommon complication, and related gastric perforation is rarely reported. Herein, we report the case of gastric perforation in a patient with VP shunt who presented with fever. The distal catheter within the stomach was confirmed by preoperative computed tomographic scan of abdomen and gastric endoscopy. Surgical intervention and appropriate antibiotics management enabled patient recovery. This case emphasizes the importance of early recognition and surgical intervention in this rare complication related to the shunt procedure. Received 9th December 2019. Accepted 23th January 2020.
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Affiliation(s)
- Yu-Hao Chen
- Section of Neurosurgery, Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi City 600, Taiwan
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25
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Gmeiner M, Thomae W, Tolino M, Senker W, Gruber A. Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature. Open Med (Wars) 2020. [DOI: 10.1515/med-2020-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Abstract
Bowel 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.
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Affiliation(s)
- Matthias Gmeiner
- Department of Neurosurgery, Kepler University Hospital , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
- Johannes Kepler University (JKU) Linz , Altenbergerstraße 69, 4040 , Linz , Austria
| | - Wolfgang Thomae
- Kepler University Hospital, Neuromed Campus, Department of Neurosurgery , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
| | - Marco Tolino
- Kepler University Hospital, Neuromed Campus, Institute of Neuroradiology , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
| | - Wolfgang Senker
- Kepler University Hospital, Neuromed Campus, Department of Neurosurgery , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
| | - Andreas Gruber
- Johannes Kepler University (JKU) Linz , Altenbergerstraße 69, 4040 , Linz , Austria
- Kepler University Hospital, Neuromed Campus, Department of Neurosurgery , Wagner-Jauregg-Weg 15A, 4020 Linz , Austria
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26
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Gadjradj PS, Willemsz L, Spoor JK. Spontaneous externalization of a ventriculoperitoneal shunt tip through the navel. Br J Neurosurg 2020:1-2. [DOI: 10.1080/02688697.2020.1716946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Pravesh S. Gadjradj
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Laura Willemsz
- Department of Neurosurgery, Sophiàs Children Hospital, Erasmus MC: University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jochem K. Spoor
- Department of Neurosurgery, Sophiàs Children Hospital, Erasmus MC: University Medical Center Rotterdam, Rotterdam, the Netherlands
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