Cerebrospinal fluid leakage from the umbilicus: Case report and literature review

Dolaş, İlyas; Apaydın, Hasan Öğünç; Yücetaş, Şeyho Cem; Uçar, M Davut; Kilinc, Suleyman; Üçler, Necati

doi:10.1016/j.ijscr.2015.12.052

Cited by 7 publications

(5 citation statements)

References 6 publications

(8 reference statements)

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“…These include catheter perforation through the umbilicus, entering an umbilical hernia, or creating a CSF fistula through the umbilicus. [2][3][4][5][6][7][8][9][10] In each of these cases, the shunt was outside the body, adherent to the umbilicus, trapped in an umbilical hernia, or infected due to a fistula causing a CSF leak. Our cases are unique because the performance of our patients' VP shunts improved once their umbilical hernias were repaired without any of the reported causes of VP shunt malfunction involving the umbilicus.…”

Section: Discussionmentioning

confidence: 99%

“…Dolas et al suggested that sterile inflammation caused softening of the tissue around an umbilicus without obvious hernia, leading to CSF fistula. 5 In two reported cases of umbilical CSF fistulas in children, umbilical hernias were believed to be contributing factors in the formation of the fistula, and the authors emphasized that the hernia must be repaired to successfully treat the fistula. 2 Another study reported that umbilical hernias increase the risk of CSF fistula formation or shunt catheter extrusion through the umbilicus and even recommended trying to repair the umbilical hernia before shunt placement if possible.…”

Section: Discussionmentioning

confidence: 99%

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Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases

Carter¹,

Ruiz-Elizalde

Gross

2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND When ventriculoperitoneal (VP) shunts and umbilical hernias coexist in the same patient, unique complications can occur. Typically, these are readily identified problems such as cerebrospinal fluid (CSF) fistulas or entrapment of the peritoneal catheter in the hernia. The authors present cases of two children whose VP shunt dysfunction resolved after repair of their umbilical hernias. OBSERVATIONS The authors present two cases of infant patients with shunted hydrocephalus and umbilical hernias. In both cases, the patients presented with distal shunt malfunctions not due to infection. Their shunt function improved once the umbilical hernia was repaired by pediatric surgery. Neither has required shunt revision since umbilical hernia repair. LESSONS Although there are case reports of VP shunts eroding through the umbilicus, developing CSF fistulas, or becoming trapped inside umbilical hernias, there is no case of VP shunt dysfunction caused by just the presence of an umbilical hernia. The authors suspect that the catheter may intermittently enter and exit the hernia. This may cause intermittent obstruction of the distal catheter, or inflammation in the hernia may occur that limits CSF absorption.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases

Carter¹,

Ruiz-Elizalde

Gross

2021

Journal of Neurosurgery: Case Lessons

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“…39 CSF umbilical fistula is more frequent than that of the trans-umbilical extrusion of the distal VPS catheter. [40][41][42][43]…”

Section: Discussionmentioning

confidence: 99%

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Ghritlaharey

2021

Int Surg J

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Trans-umbilical extrusion of the distal ventriculoperitoneal shunt catheter is a rare complication of the VPS insertion. The objectives of this review were to analyze various variables like the age, sex, indication for VPS insertion, clinical presentation, the operative therapy offered for the management, and outcome of the cases published/managed for the trans-umbilical extrusion of the distal VPS shunt catheter. In 1973, the maiden case of trans-umbilical extrusion of the distal VPS catheter was published. Literature/case reports were retrieved from 1973 to October 31, 2021. A total of n=24 (12 males, 12 females) cases were recruited for this systematic review. All of them were children below the age of 13-years. In four-fifths (n=19) of children, the initial VPS catheter was inserted during the first 6-months of life. The median age of children at the time of diagnosis of the above-described VPS complication was 7.5 (42.21 SD) months, and it ranged from 2 months to 13 years of age. The median interval from the initial VPS insertion/last VPS revision to the diagnosis of complication was 4 (24.77 SD) months, and it ranged from 3 weeks to 8 years. The main complaint was the extrusion of the distal VPS catheter through the umbilicus. Surgical procedures performed for the management were (a) removal of the entire VPS catheter n=15, (b) removal of distal/part of distal VPS catheter n=5, and (C) others n=2. For VPS catheter revision; delayed re-VPS insertion was performed in n=10, immediate revision of the distal VPS catheter in n=3, and others. Three (12.5%) children died during the postoperative and follow-up period. The distal VPS catheter extrusion through the umbilicus is a rare complication of VPS insertion, and it occurred exclusively in children. In 70% (n=17) of children, it was documented ≤6 months afterward of the VPS insertion. Delayed re-VPS catheter insertion was preferred for 40% of the children for VPS revision procedures.

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“…However, many previous studies have considered the umbilicus to be an area of anatomical and congenital weakness (a Locus Minori Resistantiae ) that predisposes the patient to external migration of the VPS distal catheter or formation of CSF umbilical fistula resulting from a patent vitello‐intestinal duct or urachal remnant (Das et al, ; Gupta et al, ; Mohindra et al, ; Kella et al, ; Ardalan et al, ). Other studies have suggested that VPS extrusion through the umbilicus is simply due to an inflammatory process that softens the tissues causing CSF leakage and catheter extrusion (Eser et al, ; Fleissig et al, ; Dolas et al, ).…”

Section: Discussionmentioning

confidence: 99%

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

et al. 2017

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There have been many reports on migration of the distal catheter of the ventriculoperitoneal shunt (VPS) since this phenomenon was recognized 50 years ago. However, there have been no attempts to analyze its different patterns or to assess these patterns in terms of potential risk to patients. We comprehensively reviewed all reports of distal VPS catheter migration indexed in PubMed and identified three different anatomical patterns of migration based on catheter extension and organs involved: (1) internal, when the catheter invades any viscus inside the thoracic, abdominal, or pelvic cavity; (2) external, when the catheter penetrates through the body wall either incompletely (subcutaneously) or completely (outside the body); and (3) compound, when the catheter penetrates a hollow viscus and protrudes through a pre-existing anatomical orifice. We also analyzed the association between each migration type and several key factors. External migration occurred mostly in infants. In contrast, internal migration occurred mostly in adults. A body wall weakness was not a risk factor for catheter protrusion. Shunt duration was a critical factor in the migration pattern, as most newly-replaced shunts tended to migrate externally. Clinicians must pay close attention to cases of large bowel perforation, since they were most often associated with intracranial infections. The organ involved in compound migration could determine the route of extrusion, as the bowel was involved in all trans-anal migrations and the stomach in most trans-oral cases. Clin. Anat. 30:821-830, 2017. © 2017Wiley Periodicals, Inc.

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Cerebrospinal fluid leakage from the umbilicus: Case report and literature review

Abstract: HighlightsNumerous abdominal complications have been reported in the literature.An umbilical cerebrospinal fluid (CSF) fistula following a VP shunt is an extremely rare complication.The mechanism of CSF leakage from the umbilicus is exactly unknown, we aimed to explain this mechanisms.

Cited by 7 publications

References 6 publications

Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases

Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

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