1
|
Wang HQ, Han P, Huang QB, Zhang ZL. Clinical Characteristics and Treatment of Early and Delayed Intra-Ccranial Infection After Ventriculoperitoneal Shunt in Adults: Retrospective Analysis of Nineteen Cases. Surg Infect (Larchmt) 2023; 24:66-74. [PMID: 36580653 DOI: 10.1089/sur.2022.269] [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: 12/31/2022] Open
Abstract
Objectives: Intra-cranial infection is the most serious complication after ventriculoperitoneal shunt (VPS). There were differences in clinical characteristics between early (occurs within one month after VPS, the early group) and delayed (occurs 1 month or more after VPS, the delayed group) infections. The aim of this study is to clarify the differences between the two groups. Patients and Methods: All cases diagnosed as intracranial infection after VPS between September 2017 and December 2021 were collected. Clinical data were reviewed and analyzed retrospectively. Results: Nineteen cases met the inclusion criteria, including 12 cases in the early group and seven cases in the delayed group. There were no significant differences between the two groups in gender, age, and etiology of hydrocephalus. Cases in the early group usually had fever with worsening consciousness (11; 91.7%), which was caused by surgical operations (10; 83.3%) with gram-positive coccis infection (9; 75.0%), whereas those in the delayed group had abdominal pain (5; 71.4%), caused by abdominal factor (7; 100%) with gram-negative bacilli infection (6; 85.7%). There were differences in symptoms (p < 0.01), causes of infection (p < 0.001), and pathogens (p < 0.05). Shunt removal was performed for all 19 cases. After the infection was controlled, eight cases received VPS again, and no re-infection occurred after a follow-up of four to 22 months. Conclusions: It is suggested in this study that there were differences between the two groups in terms of etiology, symptoms, and pathogens. The results can provide theoretical basis for prevention, early diagnosis, and reasonable treatment of infection after VPS.
Collapse
Affiliation(s)
- Hua-Qing Wang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China
| | - Ping Han
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China.,Nursing Theory and Practice Innovation Research Center of Shandong University, Shandong, P.R. China
| | - Qi-Bing Huang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China
| | - Ze-Li Zhang
- Department of Emergency Neurosurgical Intensive Care Unit, Qilu Hospital of Shandong University, Shandong, P.R. China
| |
Collapse
|
2
|
Guimarães AS, Vaz Júnior M, Martins SP, Fagundes-Pereyra WJ. Rare case of migration and perforation of the urinary bladder by ventriculoperitoneal shunt catheter with intravesical knotted formation: A case report and literature review. Surg Neurol Int 2022; 13:75. [PMID: 35399874 PMCID: PMC8986715 DOI: 10.25259/sni_804_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: 08/12/2021] [Accepted: 12/11/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The most commonly used technique in the management of hydrocephalus is a neurosurgical procedure, known as ventriculoperitoneal shunt (VPS). Several complications of the distal end of a VPS catheter have been described in the literature, although migration and erosive bladder perforation of this shunt are extremely uncommon. Case Description: We relate a rare pediatric case of a 4-year-old boy, with long-term dysuria, intermittent incontinence, and chronic abdominal pain developed during a myelomeningocele postoperative period, without other symptoms. A bladder fistula with the distal end of the VPS inside the bladder was observed while performing an ultrasound to investigate the urinary tract. Two months before the current surgical approach, the patient, with hydrocephalus and alterations compatible with Chiari malformation, was treated with VPS and subsequently subjected to the third ventriculostomy. The child was unsuccessfully treated with an infraumbilical laparotomy, with section and careful traction of the catheter. A vesicostomy was then performed and the catheter was observed to form an intravesical knot. Conclusion: The intravesical knot formation is extremely rare and its mechanism of formation is still not well understood. Patients with VPS need adequate medical follow-up to identify possible complications of the shunt.
Collapse
Affiliation(s)
- Amanda Silva Guimarães
- Department of Neurosurgery, Health Sciences Center, Federal University of Espírito Santo, Brazil
| | - Mário Vaz Júnior
- Department of Pediatric Surgery, Hospital Infantil Nossa Senhora da Glória, Vitória, Espírito Santo, Brazil
| | - Samuel Paiva Martins
- Department of Pediatric Surgery, Hospital Infantil Nossa Senhora da Glória, Vitória, Espírito Santo, Brazil
| | | |
Collapse
|
3
|
Arnaout MM, Hoz SS, Bessar AA, Agrawal A, AbdulAzeez MM, Moscote-Salazar LR, Abdelbary TH. Extrusion of a Peritoneal Catheter of a Ventriculoperitoneal Shunt from the Urethra. Neurol India 2021; 69:214-216. [PMID: 33642309 DOI: 10.4103/0028-3886.310094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mohamed M Arnaout
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
| | - Ahmed A Bessar
- Department of Radiodiagnosis, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020, Madhya Pradesh, India
| | | | - L R Moscote-Salazar
- Department of Neurosurgery-Critical Care, Red Latino, Latin American Trauma and Intensive Neuro-Care Organization, Bogota, Colombia; Department of Neurosurgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020, Madhya Pradesh, India
| | - Tarek H Abdelbary
- Department of Neurosurgery, Faculty of Medicine, Zagazig University, Sharkia, Egypt
| |
Collapse
|
4
|
Urethral migration of a ventriculoperitoneal shunt in an adult immunocompromised patient. INTERDISCIPLINARY NEUROSURGERY 2018. [DOI: 10.1016/j.inat.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
5
|
Osman B, Roushias S, Hargest R, Narahari K. Migration of ventriculoperitoneal shunt to urethral and rectal orifices. BMJ Case Rep 2017; 2017:bcr-2017-220187. [PMID: 29122895 DOI: 10.1136/bcr-2017-220187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Ventriculoperitoneal (VP) shunt surgery remains the most widely used neurosurgical procedure for the management of hydrocephalus. However, shunt complications are common and may require multiple surgical procedures during a patient's lifetime. We report the case of a 29-year-old patient with a background of Dandy-Walker malformation, occipital encephalocele, recurrent hydrocephalus, spina bifida and epilepsy presented with VP shunt migration into urinary and gastrointestinal tracts. In absence of sepsis or peritonism from either bowel or bladder perforation, local control of stent extrusion was successful for several years, although surgery was eventually undertaken.
Collapse
Affiliation(s)
- Banan Osman
- Department of Urology, University Hospital of Wales, Heath Hospital, Cardiff, UK
| | - Stella Roushias
- Department of Urology, University Hospital of Wales, Heath Hospital, Cardiff, UK
| | | | - Krishna Narahari
- Department of Urology, University Hospital of Wales, Heath Hospital, Cardiff, UK
| |
Collapse
|
6
|
Al Fauzi A, Djatisoesanto W, Wahyuhadi J, Parenrengi MA, Turchan A. A Rare Case of Repeated Migration and Transurethral Extrusion of Ventriculoperitoneal Shunt. J Pediatr Neurosci 2017; 12:96-98. [PMID: 28553396 PMCID: PMC5437805 DOI: 10.4103/jpn.jpn_189_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition.
Collapse
Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Wahjoe Djatisoesanto
- Department of Urology, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Muhammad Arifin Parenrengi
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| |
Collapse
|
7
|
Abstract
BACKGROUND Bladder perforation by ventriculoperitoneal shunt is a rare complication that has been describe in 19 cases in prior literature. CASE DESCRIPTION This work describes the case of a 4-month-old baby who presented with extrusion of the distal catheter through the urethra. The patient underwent a laparotomy; the catheter was cut close to the bladder wall and repositioned into the peritoneal cavity. The bladder wall was sutured, and the remaining distal portion of the catheter was removed through the urethra. DISCUSSION AND CONCLUSION Based on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.
Collapse
|
8
|
Gupta R, Dagla R, Agrawal LD, Sharma P. Vesical calculi formation on the slit valves of a migrated distal end of ventriculoperitoneal shunt. J Pediatr Neurosci 2016; 10:368-70. [PMID: 26962346 PMCID: PMC4770652 DOI: 10.4103/1817-1745.174444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Various complications of distal end of the ventriculoperitoneal (VP) shunt have been described in the literature. We present, here, an extremely rare and potentially severe complication of vesical calculi formation on the slit valves of distal end of VP shunt which erosively migrated into the urinary bladder. Suprapubic cystolithotomy performed, peritoneal end of the tube found to be eroding and entering into the bladder with two calculi firmly stuck to slit valves in the distal end of the tubing were removed. Shunt was functional, therefore, it was pulled out and repositioned on the superior aspect of the liver; the urinary bladder was repaired. Patient did well postoperatively. This complication was revealed 1.5 years after the shunt was implanted. Although there were symptoms of dysuria and dribbling of urine of short duration, the patient did not show obvious peritoneal signs; suggesting that, penetration of a VP shunt into the urinary bladder can remain asymptomatic for a long period of time, disclosed late and can lead to considerable morbidity. Careful follow-up is important and management should be individualized.
Collapse
Affiliation(s)
- Rahul Gupta
- Department of Pediatrics Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Rajan Dagla
- Department of Pediatrics Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Lila Dhar Agrawal
- Department of Pediatrics Surgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Pramila Sharma
- Department of Pediatrics Surgery, SMS Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
9
|
Mutlu M, Kader Ş, Aslan Y, Yazar U, İmamoğlu M. An Acute Complication of Ventriculoperitoneal Shunt with Bladder Perforation and Extrusion through the Urethra in a Newborn: Case Report and Review of the Literature. Pediatr Neurosurg 2015; 50:264-9. [PMID: 26159187 DOI: 10.1159/000433604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/27/2015] [Indexed: 11/19/2022]
Abstract
Ventriculoperitoneal shunt (VPS) surgery is a standard procedure for the management of hydrocephalus. Bladder perforation is an extremely rare complication of VPS surgery. Herein, we present for the first time an acute complication of VPS with bladder perforation and extrusion through the urethra in a newborn. We also reviewed the complication of VPS with bladder perforation as reported in the literature.
Collapse
|
10
|
Lin MS, Chen TH, Kung WM, Chen ST. Simultaneous cranioplasty and subdural-peritoneal shunting for contralateral symptomatic subdural hygroma following decompressive craniectomy. ScientificWorldJournal 2015; 2015:518494. [PMID: 25879062 PMCID: PMC4386681 DOI: 10.1155/2015/518494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/27/2015] [Accepted: 02/28/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits. MATERIAL AND METHODS Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications. RESULTS Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma. CONCLUSION The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.
Collapse
Affiliation(s)
- Muh-Shi Lin
- 1Department of Surgery, Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- 2Department of Neurosurgery, Taipei City Hospital, Zhong Xiao Branch, Taipei, Taiwan
- 3Department of Biotechnology and Animal Science, College of Bioresources, National Ilan University, Yilan, Taiwan
- *Muh-Shi Lin:
| | - Tzu-Hsuan Chen
- 4Department of Physical Medicine and Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Woon-Man Kung
- 5Department of Exercise and Health Promotion, College of Education, Chinese Culture University, Taipei, Taiwan
- 6Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan
- 7Department of Neurosurgery, Lo-Hsu Foundation, Lotung Poh-Ai Hospital, Luodong, Yilan, Taiwan
| | - Shuo-Tsung Chen
- 8Department of Mathematics, Tunghai University, Taichung, Taiwan
- 9Sustainability Research Center, Tunghai University, Taichung 40704, Taiwan
| |
Collapse
|
11
|
Aras M, Altaş M, Serarslan Y, Akçora B, Yılmaz A. Protrusion of a peritoneal catheter via abdominal wall and operated myelomeningocele area: a rare complication of ventriculoperitoneal shunt. Childs Nerv Syst 2013; 29:1199-202. [PMID: 23563809 DOI: 10.1007/s00381-013-2084-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/18/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ventriculoperitoneal shunting is mostly used in the treatment of hydrocephalus, and many complications have been reported with this method. These complications include obstruction, mechanical shunt failure, infection, and abdominal complications. Abdominal complications include intestinal obstruction, volvulus, peritonitis, peritoneal cyst, cerebrospinal fluid ascites, as well as migration of the distal catheter via the intestinal tract, umbilicus, scrotum, and vagina. Various mechanisms have been suggested with regards to the catheter migration. CASE REPORT We present a case of a 21-month-old female patient who had myelomeningocele at birth. She underwent repair of the myelomeningocele at the age of 10 days. After 4 months, cranial computed tomography revealed hydrocephalus, and ventriculoperitoneal shunt was placed. Because of shunt dysfunction, a new ventriculoperitoneal shunt system was installed at the age of 12 months. Eight months later, her mother noticed the protrusion of peritoneal catheter via abdominal wall and repaired myelomeningocele area. Revision of the lower end of the shunt was done, and myelomeningocele area was repaired again. CONCLUSION We report a unique patient with the protrusion of the distal catheter through repaired myelomeningocele area and abdominal wall in the lumbar region.
Collapse
Affiliation(s)
- Mustafa Aras
- Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, 31700, Hatay, Turkey.
| | - Murat Altaş
- Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, 31700, Hatay, Turkey
| | - Yurdal Serarslan
- Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, 31700, Hatay, Turkey
| | - Bülent Akçora
- Department of Pediatric Surgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, Hatay, Turkey
| | - Atilla Yılmaz
- Department of Neurosurgery, Tayfur Ata Sökmen Medical Faculty, Mustafa Kemal University, 31700, Hatay, Turkey
| |
Collapse
|
12
|
Urinary bladder perforation, intra-corporeal knotting, and per-urethral extrusion of ventriculoperitoneal shunt in a single patient: case report and review of literature. Childs Nerv Syst 2013; 29:693-7. [PMID: 23233212 DOI: 10.1007/s00381-012-1995-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 11/30/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ventriculoperitoneal shunt (VPS) surgery is the most common procedure performed for the treatment of hydrocephalus. Erosive bladder perforation by a peritoneal catheter is an extremely rare complication of VPS. Only ten cases involving the normal (non-augmented) urinary bladder have been reported so far. CASE We report a case of erosive bladder perforation, intra-corporeal knot formation, and perurethral extrusion of the distal end of VPS. This is the second only case report so far in the world literature showing triad of uncommon VPS complications in a single patient. CONCLUSION Prompt management could avoid further complications. Patient's parents should be aware about this rare complication, so that they can seek timely medical help.
Collapse
|
13
|
Yazar U, Kanat A, Akca N, Gazioglu G, Arda IS, Kazdal H. Urethral protrusion of the abdominal catheter of ventriculoperitoneal shunt: Case report of extremely rare complication. J Pediatr Neurosci 2012; 7:111-3. [PMID: 23248688 PMCID: PMC3519066 DOI: 10.4103/1817-1745.102571] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Hydrocephalus in its various forms constitutes one of the major problems in pediatric neurosurgical practice. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus, so that all neurosurgeons struggle with shunt malfunctions and their complications. Well-known complications are connected with the use of the valve systems (malfunction, infectious, overdrainage, secondary craniosynostosis, etc.). We report an unusual case of protruding abdominal catheter from the urethra. This girl had received a VP shunt for hydrocephalus following surgery of posterior fossa medulloblastoma 4 years ago. After admission, the entire system was removed, antibiotic treatment was administered for 2 weeks, and a new VP shunt was placed. The postoperative course was uneventful. This complication is extremely rare.
Collapse
Affiliation(s)
- Ugur Yazar
- Department of Neurosurgery, Karadeniz Technical University, Trabzon, Turkey
| | | | | | | | | | | |
Collapse
|