Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

Abstract

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.

Disappearance of a Distal Shunt Catheter: A Case Report of an Unusual Cause of Shunt Malfunction

“…Surprisingly, distal catheter scan migrate into various regions of the body. 2) Migrations into the bowel, bladder, heart, umbilicus, vagina, scrotum, pleural cavity, pulmonary 3/6 https://kjnt.org https://doi.org/10.13004/kjnt.2020.16.e3 artery, oral and anal protrusions, and even the peri-implant space of the breast have been reported. 1,2,[6][7][8][9][10]12,13,15,16,18) Our patient had not experienced any symptoms or signs related to distal catheter migration.…”

“…Perforation of the bowel by the distal catheter is potentially a lethal condition either by ascending intracranial infections or by peritonitis resulting in sepsis. 2,15) In contrast, there are few reports that have shown spontaneous healing of the perforated bowel without any signs of infection in the abdominal cavity. 16) We think a similar incident occurred in our patient.…”

“…However, the VPS is associated with multiple complications. 2,3,11) Distal catheter migration is a complicated form of mechanical shunt failure. 3) Recently, we experienced a patient with shunt malfunction secondary to distal catheter disappearance.…”

Gastric perforation by a ventriculoperitoneal shunt in an adult

“…The VPS is a surgical procedure to divert the abnormal flow or impaired absorption of cerebrospinal fluid into the peritoneal cavity for treating the intracranial hydrocephalus. [2][3][4] The migration of peritoneal catheter is a rare condition, and the incidence is approximately 1 in 1000 patients who have undergone the VPS. 2 Based on the anatomical analysis, Alloch et al 4 classified the migration of the distal catheter into 3 patterns: internal, external, and compound.…”

“…1,2 Several complications associated with the VP shunt, including obstructive, kinking, infection, disconnection, pseudocyst formation, ascites, or migration, are well documented. 3,4 Although the migration of peritoneal catheter can involve any intraabdominal organ, gastric perforation by VP shunt is rarely described; only approximately 20 cases have been reported thus far. 2,5 Herein, we report the case of patient who underwent VPS and presented with fever thereafter.…”