Abnormal migration and extrusion of abdominal end of ventriculoperitoneal shunt: An experience of eight cases

Abstract

Background:Ventriculoperitoneal (VP) shunt is commonly used in the treatment of hydrocephalus. Migration and extrusion of the distal end of the VP shunt are relatively rarely occurring complications.Aim:To retrospectively analyze patients with extrusion of the abdominal end of ventriculoperitoneal shunts and evaluate the possible etiology and outcome.Settings and Design:All patients presenting with extrusion of lower end of the shunt were included. The variables collected were age, sex, site of extrusion, time duration of extrusion, presence of local infection, meningitis, shunt dependency, and treatment received. Contrast-enhanced computed tomography of brain was carried out in all patients to rule out retrograde migration of infection in the cranial cavity.Materials and Methods:Eight patients of abnormal migration and extrusion of lower end of VP shunt were included.Results:The distal end of VP shunt was extruded from the anus (n = 3), vagina (n = 2), and anterior abdominal wall (n = 3). In five of these patients, shunt catheter was draining cerebrospinal fluid (CSF), the children were afebrile and CSF was sterile. In three children with extrusion of the shunt through the abdominal wall, the shunt tract was infected. Two of these patients had abscess in the shunt tract, which required incision and drainage. Both these patients had meningitis with a growth of Streptococcus species from CSF. Seven patients required further CSF diversion such as endoscopic third ventriculostomy (n = 3) or placement of VP shunt (n = 4).Conclusion:Distal tip migration of VP shunt may prove to have potentially serious complications such as meningitis. A prompt and aggressive protocol of management is recommended.

Ventriculoperitoneal Shunt Migration Into the Transverse Colon: A Case Report

“…Children are more likely to have shunt migration mostly due to the shorter travel distance between the caudal and the cranial ends and their growth spurt. A malnourished kid is more vulnerable because there is less subcutaneous fat to hold the tube in place [ 10 ]. An increase in the intra-abdominal pressure could also affect the drainage of CSF, which could encourage the extrusion of the shunt through the anal orifice, as seen in this case.…”

“…An increase in the intra-abdominal pressure could also affect the drainage of CSF, which could encourage the extrusion of the shunt through the anal orifice, as seen in this case. However, shunt migration varies among patients depending on the compartment of migration, the direction of migration (cranial or caudal), and the component of the shunt that migrates (proximal catheter, distal catheter, valve, reservoir, or whole shunt system) [ 10 ].…”

“…An infection is considered a fatal consequence of the mechanical displacement of the shunt. If local infection of the shunt tract proceeds, it is best to administer broad-spectrum intravenous antibiotics to prevent the infection from spreading, leading to the CNS [ 10 ].…”

Anal extrusion of silent migrated ventriculoperitoneal shunt: Case report and literature review

“…However, VP shunt complications remain high [4] . Shunt failure is the most common complication of VP shunts, and 70%-80% of cases need revision and proceed by shunt infection [5] and [6] . Ghritlaharey et al.…”

“…Thereafter, once the shunt enters the lumen of the intestine, the strong peristaltic activity pushes the catheter towards the anus [10] . There is no rational treatment option for these patients, and the management is individualized according to case-specific factors such as meningitis, the presence of shunt infections, and dependence on shunts [13] .…”