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Zarra F, Shahid AH, Gandhi DN, Salazar LRM, Chaurasia B. Migration of the anal distal end due to ventriculoperitoneal shunt placement: an atypical case report of a 9-month-old infant with tuberculous meningitis and review of the literature. Childs Nerv Syst 2024; 40:2583-2592. [PMID: 38625589 DOI: 10.1007/s00381-024-06405-9] [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: 02/21/2024] [Accepted: 04/12/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Ventriculoperitoneal shunt (VPS) represents one of the most classic and widely used treatments for hydrocephalus in pediatric patients. Migration and externalization of the distal end of the catheter through the rectum are extremely rare complications of intestinal perforation with devastating consequences such as meningitis or peritonitis due to enteric bacteria that are significantly life-threatening. Besides, one of the biggest topics with that is that it can happen without producing symptoms, like the patient we present in this case report, which further masks the condition and puts the patient's life more at risk. CASE PRESENTATION We present a case of a 9-month-old infant patient, with a history of prematurity, tuberculous meningitis (TBM), and hydrocephalus, who came to ED with a functional VPS and the distal end of the catheter protruding outside the rectum for 7 days, without presenting neurological or intestinal symptoms accompanying. One of the parameters that guided the diagnosis and made us suspicious of asymptomatic intestinal perforation (IP) was the background of TMB. The patient was immediately transferred to the OR where both ends of the shunt were removed: in the first instance, the shunt tube was disconnected through the abdomen, thus withdrawing through the anus, and subsequently, the proximal end of the catheter was exteriorized. In turn, the intestinal fistula was successfully repaired laparoscopically, and prophylactic antibiotic treatment was early administered. On the 6th postop day, a shunt was internalized, and a child was discharged on postop day 15 without complications with alarm guidelines. CONCLUSIONS The authors of this article strongly suggest that (1) anal extrusion of catheters is an uncommon complication but real: for this reason, its development should be considered in all patients with VPS, especially in infants. (2) The patients are often asymptomatic since false tracts can form around the catheter protecting it from spillage, and thus can be removed without complications. (3) Special care should be taken in patients with conditions that increase the risk of developing IP, such as TMB.
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Affiliation(s)
- Francisco Zarra
- Department of Neurosurgery, University of Buenos Aires School of Medicine, Buenos Aires, Argentina.
| | | | | | | | - Bipin Chaurasia
- Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
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2
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karshe NA, Osman FAO, Elmi AM, Mohamed Dirie A. Anal extrusion of silent migrated ventriculoperitoneal shunt: Case report and literature review. Radiol Case Rep 2024; 19:1524-1527. [PMID: 38304348 PMCID: PMC10832370 DOI: 10.1016/j.radcr.2023.11.067] [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: 11/08/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 02/03/2024] Open
Abstract
The standard surgical treatment for hydrocephalus is ventriculo-perioneal shunting with shunt failure being the most common complication. A rare and serious consequence is intestinal perforation. A malnourished 9-month-old boy presented with anal protrusion of the distal migrated ventriculoperitoneal (VP) shunt after 2 months of shunt placement. An abdominal X-ray and a brain CT scan were performed. Following the correction of malnourishment and electrolyte imbalance, the patient underwent surgical management, with uneventful discharge on the third day of the procedure. To avoid potentially fatal complications such as sepsis and meningitis, prompt diagnosis and treatment are crucial in these cases.
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Affiliation(s)
- Nur Abdullahi karshe
- Neurosurgery Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Faisal Abdi Osoble Osman
- Radiology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Abdinasir Mohamed Elmi
- Radiology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
| | - Abdikadir Mohamed Dirie
- Radiology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia
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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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Wright SR, Gabby LC, Nguyen BT. Cerebrospinal fluid as vaginal discharge: ventriculoperitoneal shunt migration following Cesarean section. Minerva Obstet Gynecol 2023; 75:498-501. [PMID: 37768257 DOI: 10.23736/s2724-606x.22.05091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Congenital hydrocephalus was once a permanently disabling and even fatal disease. With the advent of ventriculoperitoneal shunts, affected women are now surviving to their reproductive years and beyond. Pregnancy outcomes in this population are generally positive. However due to possible shunt complications, including infection, migration, and organ perforation, perinatal care for pregnant individuals with a ventriculoperitoneal shunt is complex and requires input from both obstetric and neurosurgical providers. We present the case of a 28-year-old G1P1 with a history of congenital hydrocephalus and ventriculoperitoneal shunt who presented to the emergency department at two months postpartum with clear fluid leaking from her vagina. The shunt's distal end had migrated and perforated the uterus causing cerebrospinal fluid to leak into the uterine cavity. Surgical repair was required of both the uterine hysterotomy and ventriculoperitoneal shunt, and the patient's symptoms ultimately resolved. Patients with a history of shunt placement who later undergo abdominal surgery, including cesarean section, are at risk for shunt complications. Shunt-dependent patients presenting in the post-partum period with new neurological or abdominopelvic complaints should undergo evaluation by a multidisciplinary team.
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Affiliation(s)
- Steffanie R Wright
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA -
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA -
| | - Lauryn C Gabby
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Maternal Fetal Medicine, University of California, San Diego, CA, USA
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Bal'afif F, Wardhana DW, Alfandy TN, Inggarwati L, Ardiansyah R, Ferdiansyah F, Mustofa M. Chest wall abscess with intestinal perforation and distal catheter migration of Ventriculoperitoneal (VP) shunt without anal extrusion: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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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Alanazi RF, Saeed M, Azzubi MA. Parieto-Occipital Shunt Migration in a Patient with Congenital Hydrocephalus and Dandy-Walker syndrome: Case report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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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.
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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
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Xie D, Chen H, Guo X, Liu Y. Comparative study of lumboperitoneal shunt and ventriculoperitoneal shunt in the treatment of idiopathic normal pressure hydrocephalus. Am J Transl Res 2021; 13:11917-11924. [PMID: 34786122 PMCID: PMC8581892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to compare lumboperitoneal shunt (LPS) and ventriculoperitoneal shunt (VPS) in the treatment of idiopathic normal pressure hydrocephalus (iNPH). METHODS From September 2016 to November 2019, 76 iNPH patients who underwent shunt operation were recruited and assigned to a lumboperitoneal shunt group (LPS group, n=40) and a ventriculoperitoneal shunt (VPS group, n=36) according to different treatment methods. The right first time (RFT) and improvement in triad of the two groups were observed. Keifer's hydrocephalus score (KHS) was used to evaluate the improvement of clinical symptoms, Mini-Mental State Examination (MMSE) and National Institutes of Health Stroke Scale (NIHSS) were used to evaluate the improvement of cognitive function, and the Functional Independence Measure (FIM) to evaluate the postoperative living status of patients. The two groups of patients were followed up for 6 months to observe the postoperative curative effect and incidence of complications. RESULTS The RFT of LPS group was markedly higher than that of VPS group. There was no remarkable difference in the improvement of triad, KHS score, MMSE score, NIHSS score, and FIM score between the two groups after treatment, as well as overall response rate (ORR) after six months. The total incidence of complications in LPS group was considerably lower than that in VPS group. CONCLUSION LPS and VPS have similar curative effect in the treatment of iNPH, but LPS can avoid intraparenchymal hemorrhage (IPH) caused by ventricular puncture, and it increases the RFT.
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Affiliation(s)
- Dongcheng Xie
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| | - Hongwei Chen
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| | - Xiaochuan Guo
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
| | - Yiran Liu
- Department of Neurosurgery for Cerebrospinal Fluid Diseases, Aviation General Hospital of China Medical University Chaoyang District, Beijing 100012, China
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Case report of mesenteric strangulation secondary to longstanding ventriculoperitoneal shunt catheter. Childs Nerv Syst 2021; 37:2719-2722. [PMID: 33388923 DOI: 10.1007/s00381-020-05019-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunts are the most common treatment for hydrocephalus in both pediatric and adult patients. Complications resulting from the abdominal portion of shunts include tube disconnection, obstruction of the shunt tip, catheter migration, infection, abdominal pseudocysts, and bowel perforation. However, other less common complications can occur. The authors present a unique case of a patient with a longstanding VP shunt presenting with an acute abdomen secondary to knotting of the peritoneal portion of the catheter tubing. CASE DESCRIPTION A 13-year-old male with past medical history significant for myelomeningocele, requiring ventriculoperitoneal shunt placement at 18 months of age, presented to an outside hospital with chief complaint of abdominal pain. Cross-sectional imaging revealed spontaneous knot formation within the shunt tubing around the base of the small bowel mesentery. He was then transferred to our facility for general and neurosurgical evaluation. His abdominal exam was notable for diffuse distension in addition to tenderness to palpation with guarding and rebound. Given his tenuous clinical status and peritonitis, he was emergently booked for abdominal exploration. He underwent bowel resection, externalization of his shunt, with later re-anastomosis and shunt internalization. He eventually made a full recovery. DISCUSSION Given the potential for significant bowel loss with this and other shunt-related complications, this case serves as a reminder that even longstanding VP shunts should be considered in the differential diagnosis of abdominal pain in any patient with a shunt.
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Pant N, Singh S, Singh G, Kumar A, Rai RK, Rawat J, Wakhlu A. The wandering ventriculoperitoneal shunt and the scope of its salvage. Childs Nerv Syst 2021; 37:2613-2618. [PMID: 33963923 DOI: 10.1007/s00381-021-05198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Distal shunt tube migration following ventriculoperitoneal (VP) shunt placement in children is mostly managed by an initial shunt diversion/removal and subsequent replacement. Lately, shunt salvage is being used as an alternative in certain conditions. We have focused on the situations where one can consider or disregard shunt salvage in such cases. METHOD A retrospective study of children treated for distal shunt migration following VP shunt placement between January 2013 and December 2019. RESULT Seventeen children were managed for over 7 years. These included cutaneous extrusions (n = 4), hollow viscus perforation (n = 6), inguinal hernias (n = 5), and umbilical extrusion (n = 2). The surgical treatment varied from a cutaneous wound closure (with a tube in situ), temporary external shunt diversion, and laparotomy with shunt reposition into the peritoneal cavity. Shunt salvage was possible in three cases, whereas in 2 cases even though shunt salvage was possible, it was not feasible due to a short residual shunt length. CONCLUSION VP shunt salvage is possible in certain cases of distal shunt migration with a functional uninfected shunt. Small cutaneous extrusions can be covered by a local skin flap. Also, one should consider the residual intraperitoneal shunt length before its salvage in small children.
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Affiliation(s)
- Nitin Pant
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sudhir Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Gurmeet Singh
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Akhilesh Kumar
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rahul Kumar Rai
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jiledar Rawat
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ashish Wakhlu
- Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India.
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Mullens CL, Twist J, Meltzer HS, Parrish DW. The "SHIFT" technique: Suprahepatic IntraFalciform tubing for placement of ventriculoperitoneal shunts. J Pediatr Surg 2021; 56:1246-1250. [PMID: 33752912 DOI: 10.1016/j.jpedsurg.2021.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/27/2021] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
Ventriculoperitoneal (VP) shunts in pediatric patients are an important aspect of management for patients with hydrocephalus and are fraught with complications. Surgical revision rates for VP shunts in the pediatric population are currently high, which necessitates innovation in operative techniques for placing VP shunts in attempt to decrease complication risks. Here we describe a novel approach for placement of VP shunts that we hypothesize can reduce potential morbidity among pediatric patients. By utilizing the falciform ligament of the liver and the suprahepatic recess to suspend and maintain the shunt, outcomes may portend fewer iatrogenic intra-abdominal injuries, enhanced ease of shunt removal, provide a large surface area for absorption of drained cerebrospinal fluid, and result in fewer adhesions secondary to device placement. We are referring to the operative technique as the "SupraHepatic IntraFalciform Tubing" (SHIFT) technique. In summary, the SHIFT shunt is fashioned by creating a window through the falciform ligament, inserting the shunt, and placing tubing in the suprahepatic recess.
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Affiliation(s)
| | - Joanna Twist
- West Virginia University School of Medicine, Morgantown, WV, United States
| | - Hal S Meltzer
- Department of Neurosurgery, Division of Pediatric Neurosurgery, West Virginia University School of Medicine, Morgantown, WV, United States
| | - Dan W Parrish
- Department of Surgery, Division of Pediatric Surgery, West Virginia University School of Medicine, Morgantown, WV, United States
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13
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Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications. AJR Am J Roentgenol 2020; 216:187-199. [PMID: 33112667 DOI: 10.2214/ajr.20.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
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14
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Alolyani A, Al Dandan F, Al-Umran S, Ammar A. Extrusion of Anterior Abdominal Wall by a Ventriculoperitoneal Shunt - An Uncommon Complication: Case Report and Literature Review. Asian J Neurosurg 2020; 15:425-427. [PMID: 32656146 PMCID: PMC7335134 DOI: 10.4103/ajns.ajns_347_19] [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: 11/29/2019] [Revised: 02/05/2020] [Accepted: 04/08/2020] [Indexed: 11/24/2022] Open
Abstract
Ventriculoperitoneal shunt (VP-shunt) is a commonly performed procedure for the management of hydrocephalus. Migration of the distal end of VP-shunt is one of the rarest complications. The authors report a case of an 11-year-old boy who presented with a spontaneous extrusion of the distal end of the VP-shunt through an intact abdominal wall. Literature was reviewed regarding the possible causes of such complication and the management approach in similar cases. The suggested phenomenon for this case could be attributed to the continuous hammer effect of the cerebrospinal fluid (CSF) pulsations on the abdominal wall. It is important to assess the future need for long-term CSF diversion, as in this case, the patient did not require reinsertion of a new shunt system because he was shunt independent.
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Affiliation(s)
- Amira Alolyani
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Al Dandan
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shaymaa Al-Umran
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Ahmed Ammar
- Department of Neurosurgery, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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15
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Korulmaz A, Alakaya M, Kaya S, Hamzaoglu V, Tezol Ö, Arslanköylü AE. A Rare Cause of Vaginal Foreign Body: Ventriculoperitoneal Shunt Migration. J Pediatr Neurosci 2019; 14:109. [PMID: 31516634 PMCID: PMC6712915 DOI: 10.4103/jpn.jpn_172_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ali Korulmaz
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Mehmet Alakaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Sadık Kaya
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Vural Hamzaoglu
- Department of Neurosurgery, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Özlem Tezol
- Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ali E Arslanköylü
- Department of Pediatric Intensive Care, Faculty of Medicine, Mersin University, Mersin, Turkey
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