Complete migration of peritoneal shunt tubing to the scalp

Abstract

The entire length of distal tubing from a ventriculoperitoneal shunt was found to have migrated into the subgaleal space, and resulted in a shunt obstruction. Upward migration of distal shunt catheters has rarely been reported, but probably involves patient motion that creates a "windlass" effect. Cephaled migration requires a potential space (subgaleal or ventricular) and no resistance to movement of the tubing. This complication can be prevented by securing the shunt near the site of motion.

Ventricular migration of shunt: Chhabra shunt complication

“…[1][2][3]10,11,13,16,17,19,22 Almost all have reported such cases in malnourished infants with complicated postoperative course. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Heim and Kim have reported migration of ventriculoperitoneal shunt to subgaleal and subdural spaces. 4,5 The probable cause of retrograde migration is a much debated subject with numerous hypothesis forwarded in literature.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Heim and Kim have reported migration of ventriculoperitoneal shunt to subgaleal and subdural spaces. 4,5 The probable cause of retrograde migration is a much debated subject with numerous hypothesis forwarded in literature. One of the earliest reported cases of complete Intraventricular migration of shunt systems were in 70s by Mori & Villarejo.…”

“…It's a notorious procedure with many complications ranging from blockage, infection, migration to peritoneal cavity, bladder, pleural cavity. [1][2][3][4] We are reporting the rarest complication in which there was complete migration of whole shunt into the ventricles and discuss the reported cases and try to form a hypothesis about the causes of this complication.…”

Retrograde migration of ventriculoperitoneal shunt to the neck: Case report

“…Most instances of this occurrence have been related with the use of unishunts and valveless systems 1,12,13 . Subcutaneous coiling at the scalp adjacent to the burr-hole has also been illustrated in several cases 3,5,6,11 . To our knowledge there is only another instance of relocation of the whole shunt system in the subcutaneous tissues at the supraclavicular region 6 .…”

“…Mechanical complications, especially those related to shunt-parts disconnection and downward catheter migration have diminished with the growing use of shunts made up with soldered pieces. Although rarely, all components of the shunt systems (reservoir, valve and ventricular or distal catheters) may be displaced from their original position and migrate to diverse parts of the body [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . The retrograde migration of peritoneal or venous catheters through the subcutaneous tract of the shunt tubing has been reported in several occasions [1][2][3][4][5][6][8][9][10][11][12][13][14] .…”