Migration of a Distal Ventriculoperitoneal Shunt Catheter Into the Internal Jugular Vein and Heart Through the External Jugular Vein -Case Report-

Abstract

A 6-year-old boy had undergone ventriculoperitoneal (VP) shunt for acute hydrocephalus because of a brain tumor at the age of 11 months, and presented with vomiting and somnolence after the shunt malfunctioned 6 days after VP shunt reconstruction, during which the right external jugular vein was injured during the tunneling process and the peritoneal catheter was not fixed to the peritoneum with a purse string suture. Radiography revealed an abnormal route of the peritoneal catheter, suggesting that the distal VP shunt catheter had migrated into venous vasculature through the right external jugular vein. Computed tomography revealed that the peritoneal catheter had migrated into the internal jugular vein and the right atrium. At surgery, the peritoneal catheter was exposed through a small incision on the subclavicular region, was easily extracted from the internal jugular vein and the heart as there was no coiling or adhesion of the distal catheter to the vascular tissues, and was repositioned into the peritoneum with weak fixing between the subcutaneous tissues of the right subclavicular region and the right abdominal rectus muscle fascia as a temporary emergency measure. Peritoneal shunt migration into the internal jugular vein and the heart through the external jugular vein can be lethal because of pulmonary infarction or arrhythmia, and must be detected as soon as possible. Periodic follow-up radiography should be scheduled after VP shunt placement, even in the absence of symptoms.

An Ectopic External Jugular Vein Draining into the Axillary Vein

“…In the case described, the right cephalic vein formed a common trunk with the right external jugular vein, hence, introduction of a lead into the particular cephalic vein would result in its placement in the external jugular vein. Anatomical variations of the EJV are also relevant for catheterization and the implementation of ventriculoperitoneal shunting for treatment of hydrocephalus (16). Conducting a contrast venography prior to the procedure enables the surgeon to visualize the morphology of the veins and enhances success rates, as well as ensuring time and effort efficiency by reducing unnecessary manipulation.…”

Delayed peritoneal shunt catheter migration into the pulmonary artery with indolent thrombosis: A case report and narrative review

“…Surgical strategies to correct SCMPA range from open revision surgery with catheter manipulation using gentle traction at the most proximal site to endovascular retrieval using loop snare device. [ 7 , 15 , 17 , 20 , 35 ] Alternatively, catheter manipulation under intraoperative fluoroscopy, open thoracotomy, or a combination of these techniques may be used. [ 10 , 16 , 26 ] In the presence of significant intravascular looping or catheter knotting, open revision with proximal retrieval may be inadequate.…”

Upward spontaneous migration of ventriculoperitoneal shunt into the heart: A case report summary

“… 12 Kano et al also reported the migration of the VP shunt catheter into the internal jugular vein and right atrium, in which the catheter was removed with a small incision in the subcutaneous area and fixed in the abdomen. 13 Ruggiero et al postulated that the possible cause of VP shunt catheter migration through the internal jugular vein is the result of direct damage to the arteries during tunneling. 14 Moreover, negative intrathoracic pressure and venous flow together augment the possibility of catheter migration into the heart.…”