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González-Pombo M, Torri JA, Olivares Blanco M. Ventriculoperitoneal shunt migration into the pulmonary artery: Case report and literature review. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:321-325. [PMID: 36775740 DOI: 10.1016/j.neucie.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 08/10/2022] [Indexed: 06/18/2023]
Abstract
Cerebrospinal fluid (CSF) shunt placement is a commonly performed procedure for patients with hydrocephalus of various etiologies. We present the case of a 68-year-old male patient treated with a ventriculoperitoneal shunt for obstructive hydrocephalus management. Eight years later, a computed tomography (CT) scan detected migration of distal catheter into the pulmonary artery. We conducted a systematic review in Medline database using PubMed search engine to identify previous cases and their management. Our literature review identified eighteen single case reports describing this complication and different strategies to attempt catheter retrieval. To the best authors' knowledge, this is the first case where conservative management was chosen.
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Affiliation(s)
- Marta González-Pombo
- Neurosurgery Department, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain.
| | - Juan Alberto Torri
- Neurosurgery Department, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain
| | - Magdalena Olivares Blanco
- Neurosurgery Department, Hospital Universitario Virgen del Rocío, Avenida Manuel Siurot s/n, 41013 Sevilla, Spain
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González-Pombo M, Torri JA, Olivares Blanco M. Ventriculoperitoneal shunt migration into the pulmonary artery: Case report and literature review. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Xue Y, Mranda GM, Wei T, Wang Y, Zhou XG, Liu ZP, Gao ZX, Ding YL. The shadow in the darkness: Case report on adhesive intestinal obstruction secondary to ventriculoperitoneal shunt catheter in an elderly patient. Ann Med Surg (Lond) 2022; 77:103661. [PMID: 35638005 PMCID: PMC9142647 DOI: 10.1016/j.amsu.2022.103661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Shunt placement is an effective therapy for hydrocephalus. Ventriculoperitoneal shunt draining excess cerebrospinal fluid connects the cerebral ventricles to the abdominal cavity. However, intestinal obstruction may ensue as an infrequent complication of the shunt. Case presentation A 65 years old female patient presented with abdominal pain, abdominal bloating, and ceased passage of flatus and stool for six days. She had a history of undergoing a VP shunt procedure due to midbrain obstruction and supratentorial hydrocephalus. Conservative treatment at another local hospital couldn't relieve her symptoms. Laboratory investigations revealed elevated CRP and neutrophils. CT scan showed distended small bowel loops with aerated effusion. Thus, she was admitted to our hospital and underwent an emergent laparotomy following diagnostic modalities completion. Discussion Adhesive intestinal obstruction secondary to ventriculoperitoneal shunt is a rare but fatal shunt complication. The possible mechanisms involved include rubbing movements between the greater omentum and the catheter, cerebrospinal fluid reaction with abdominal organs, immunological rejection of the catheter, and deposition of brain tumor cells with the resultant abdominal metastatic lesions. Laparoscopic and laparotomy are warranted in the surgical management of the disease. Conclusion A high index of suspicion for adhesive intestinal obstruction is key to timely diagnosis and treatment. Ventriculoperitoneal (VP) shunt is the standard treatment for hydrocephalus. The common complications include bacterial infection and shunt malfunction. Adhesive intestinal obstruction is an infrequent VP catheter complication. Focused history, physical examination, and diagnostic modalities are of value. In emergencies, laparotomy is key in alleviating the disease's detrimental effects.
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Affiliation(s)
- Ying Xue
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
- Department of General Surgery, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Geofrey Mahiki Mranda
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Tian Wei
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Yu Wang
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Xing-Guo Zhou
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Zi-Ping Liu
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Zhong-Xia Gao
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
| | - Yin-Lu Ding
- Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong Province, China
- Corresponding author. Department of Gastrointestinal Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Street, Jinan, 250012, Shandong Province, China.
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Patel MS, Zhang JK, Khan ASR, Alexopoulos G, Khan MQ, Mercier PJ, Kemp JM. Delayed peritoneal shunt catheter migration into the pulmonary artery with indolent thrombosis: A case report and narrative review. Surg Neurol Int 2022; 13:77. [PMID: 35399878 PMCID: PMC8986728 DOI: 10.25259/sni_1150_2021] [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: 11/17/2021] [Accepted: 02/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Ventriculoperitoneal (VP) shunts are the preferred surgical treatment for hydrocephalus, and rarely, these operations may be complicated by catheter migration to ectopic sites. We present the case of an asymptomatic VP shunt patient with delayed peritoneal catheter migration into the pulmonary artery shunt catheter migration into the pulmonary artery (SCMPA) complicated by knotting and indolent thrombosis, necessitating open-heart surgery for system retrieval. Methods: We conducted a literature review in PubMed, Scopus, and Web of Science of prior similar reported cases and present the results of 24 cases of SCMPA. Results: An asymptomatic 12-year-old male presented with SCMPA noted on routine annual follow-up imaging. Preoperative CT angiogram indicated extensive catheter looping into the pulmonary artery without evidence of thrombosis. Less invasive attempts to retrieve the retained catheter were unsuccessful, and open-heart surgery was required. Intraoperatively, a nonocclusive pulmonary arterial thrombus surrounding the knotted catheter was discovered that was lysed successfully before system retrieval. Conclusion: VP shunt catheter migration into the pulmonary artery (SCMPA) with concurrent large vessel thrombosis can develop in pediatric patients incidentally without any clinical symptoms. Our report suggests that preoperative CT angiogram may be insufficient to detect arterial thrombosis in the presence of extensive intravascular catheter knotting. An open-chest approach may be the only viable surgical option for catheter retrieval in the presence of complex catheter coiling. The use of anticoagulation following open-heart surgery for retrieval of a migrated VP shunt catheter remains unclear, we here propose that continuation of long-term therapeutic anticoagulation may successfully prevent thrombus relapse.
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Affiliation(s)
- Mayur S. Patel
- Department of Neurosurgery, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
| | - Justin K. Zhang
- Department of Neurosurgery, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
| | - Ali Saif Raza Khan
- Department of Neurosurgery, Texas Tech University Health Sciences Center, Lubbock, Texas, United States
| | - Georgios Alexopoulos
- Department of Neurosurgery, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
| | - Maheen Q. Khan
- Department of Neurosurgery, Saint Louis University, Saint Louis, Missouri, United States
| | - Philippe J. Mercier
- Department of Neurosurgery, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
| | - Joanna M. Kemp
- Department of Neurosurgery, Saint Louis University School of Medicine, Saint Louis, Missouri, United States
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Sayore CM, Hemama M, de Paule Kossi Adjiou F, Moune MY, Sabur S, El Fatemi N, El Maaqili R. Thoracic abscess due to unusual migration of a ventriculoperitoneal shunt and literature review. Surg Neurol Int 2021; 12:467. [PMID: 34621582 PMCID: PMC8492440 DOI: 10.25259/sni_699_2021] [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: 07/15/2021] [Accepted: 08/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Thoracic complications of ventriculoperitoneal (VP) cerebrospinal fluid shunting are rare and the diagnosis is difficult without neurological impairment. Case Description: We report a case of a 36-year-old woman who had a VP shunt in the right side when she was 13 years for a posterior fossa ependymoma and hydrocephalus. 23 years after surgery, she developed acute yellowfish cough and sputum, and the computed tomography scan found an intrathoracic cyst. She had a thoracotomy for the cyst and during surgery, we found the peritoneal catheter of the VP shunt, with a collected abscess in the left side. The patient was treated for the abscess and the VP shunt was removed. We also review the literature cases of thoracic complications after VP shunts. Conclusion: Thoracic abscess due to VP shunt migration is extremely rare and could happen after a long time delay VP shunt surgery.
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Affiliation(s)
| | | | | | | | - Safa Sabur
- Department of thoracic surgery, Chu Ibn Sina Rabat, Rabat, Morocco
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Adib SD, Lescan M, Renovanz M, Schuhmann MU, Trakolis L, Bongers M, Tatagiba M, Döbele A, Grözinger G. Intracardial Catheter Migration of a Ventriculoperitoneal Shunt: Pathophysiology and Interdisciplinary Management. World Neurosurg 2020; 135:222-227. [PMID: 31877393 DOI: 10.1016/j.wneu.2019.12.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/13/2019] [Accepted: 12/15/2019] [Indexed: 10/25/2022]
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