CSF Fistula through the Umbilicus following a Shunt Surgery: A Case Report and Literature Review

Abstract

Background: Ventriculoperitoneal shunting is among the commonest neurosurgical operations. Shunt catheters within the peritoneal cavity have migrated through and perforated almost all the intra-abdominal hollow viscera. Case Description: A unique case of an infant is presented, in whom CSF leaked via a fistulous opening through the umbilicus. The embryological aspect of this anomalous communication is described, along with all the 7 cases previously reported with their pathophysiological causes. Conclusions: The CSF fistula through the umbilicus may be due to varying pathological causes. The present paper describes an altogether new pathological cause behind such a complication, with a re-visit to all other described causes. The present description of a patent intercoelomic communication, an embryological remnant, puts a new light on this 3-decade-old complication.

Spontaneous Umbilical Cerebrospinal Fluid Fistula due to Transdermal Dislocation of the Ventriculoperitoneal Distal Shunt Ending – A Case Report

“…Interestingly, only a few cases reports, probably less than 10, mentioned abdominal complications, most of these patients were children. [1][2][3][4][5]8,9,11,12,17,19 In our case, neither persistence of a vitellointestinal duct 8,13 nor structural malformations of the umbilicus 21 were detectable as contributing factors. In the literature, some authors assume that the role of the umbilicus as a "locus minori resistantiae" may be the main reason for the pathogenesis of this complication.…”

“…The most serious complications of this treatment are disconnection, breaking, kinking and tip occlusion of the tube, shunt infection, intestinal obstruction, migration of the shunt catheter, and the perforation of internal organs. 1,4,9,12 In addition, the literature illustrates a few extremely unusual complications, 4,5,9,13 such as skin fistula in the thoracic or umbilical region. Thus, we report on a rare case of secondary transumbilical peritoneal shunt perforation after VPS placement in a patient with normal-pressure hydrocephalus.…”

Spontaneous knotting of peritoneal catheter: A report of an asymptomatic patient

“…The common abdominal complications include spontaneous extrusion of the peritoneal catheter, obstruction due to fibrous encasement, shunt migration, infection, and cerebrospinal fluid (CSF) fistulas. [1] In the present communication, we describe a case with spontaneous knot formation at the peritoneal end of a VP shunt with no shunt block and detected incidentally.…”

“…[1] Presently, the patient presented to us with a boil on his lower part of anterior chest wall [Figure 1]. Owing to its proximity to the shunt tract, the child was investigated for possible cellulitis of the shunt tract and shunt infection.…”

CSF Hygroma in the Neck: Rare Complication of Ventriculoperitoneal Shunt

“…Although the risk in performing a shunt operation is low, the complications related to VP shunts are many with a reported incidence of 24–47%, of which abdominal complications are reported to occur in 25% [1]. Other rare complications include migration of the peritoneal catheter into the stomach, gall bladder, urinary bladder, vagina, bowel, liver, spontaneous umbilical CSF fistula and cervical myelopathy [2,3,4]. The complications related to shunt use are commonly classified as infectious (5–10%), mechanical or functional, and they may be neurological or nonneurological [1, 2, 5].…”