Retrograde migration of ventriculoperitoneal shunt to the neck. Case report

Felipe-Murcia, M.; Almagro, María-José; Martínez‐Lage, Juan F.

doi:10.1016/s1130-1473(06)70330-x

Cited by 8 publications

(12 citation statements)

References 11 publications

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“…17 Subsequent leakage of CSF from the catheter and distension of the subcutaneous tunnel could reduce resistance to retrograde movement of the catheter. The distension of the subcutaneous tract could act as a buffer and account for the initial lack of neurological signs of raised intracranial pressure seen in some people with VPS migration, 16,19,32 as was seen in this case. Normal feline activities (eg, jumping, climbing and hunting) could trigger the above proposed mechanism, perhaps creating an increased risk of PC migration in cats that are younger, more active and/or have an outdoor lifestyle compared with those cats that are older, less active and/or confined indoors.…”

Section: Discussionsupporting

confidence: 50%

Retrograde migration and subcutaneous coiling of the peritoneal catheter of a ventriculoperitoneal shunt in a cat

Bennett

Behr

2016

Journal of Feline Medicine and Surgery Open Reports

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Case summary Ventriculoperitoneal shunt placement is the most commonly utilised surgical treatment for hydrocephalus in human and veterinary patients. Migration of the peritoneal catheter is an uncommon but well-documented complication in people, usually occurring within the first 3 months postoperatively, although only a single feline case report exists. A ventriculoperitoneal shunt was placed in a domestic shorthair cat, aged 4 years and 10 months, following a diagnosis, with MRI, of unilateral, non-communicating hydrocephalus. Diarrhoea, increased vocalisation and pruritus were reported within the first 3 months postoperatively. A shunt-associated seroma developed, which was aspirated under ultrasound guidance. Within 3 days, the entire peritoneal catheter was subcutaneously coiled at the level of the seroma. The peritoneal catheter was replaced within the abdomen via a new subcutaneous tunnel. No further complications had occurred 24 months following revision surgery.Relevance and novel information This is the second report describing peritoneal catheter migration in a cat. Repetitive head and neck movements during self-grooming, raised intra-abdominal pressure secondary to vocalisation and tenesmus, and negative pressure exerted during seroma aspiration may have contributed to ventriculoperitoneal shunt migration. Excessive loose skin and increased activity may further increase the risk of migration in cats. Diagnostic imaging should be offered prior to and following aspiration of shunt-associated swellings, and minimal negative pressure should be exerted. Attempts to reduce the frequency of postoperative self-grooming, prevention and prompt treatment of conditions predisposing to raised intra-abdominal pressure and moderate exercise restriction, particularly within the first 3 months, may help reduce the risk of peritoneal catheter migration.

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Section: Discussionsupporting

confidence: 50%

Retrograde migration and subcutaneous coiling of the peritoneal catheter of a ventriculoperitoneal shunt in a cat

Bennett

Behr

2016

Journal of Feline Medicine and Surgery Open Reports

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“…3,11,15 Peritoneal catheter migration has also been described ending into the pulmonary vein and cardiac chambers, chest cavity, and around augmented breast implants. 4,5,13,15 This case report illustrates 2 unusual complications of CSF shunting occurring in the same patient.…”

Section: Discussionmentioning

confidence: 99%

Proximal subcutaneous migration of the distal end of a ventriculoperitoneal shunt presenting with recurrent cerebrospinal fluid galactorrhea

Maknojia

Caron²

2014

JNS

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V entriculoperitoneal shunt insertion is a wellestablished technique for permanent CSF diversion to treat a variety of intracranial pathological conditions most often resulting in hydrocephalus, but it is also used to treat other disorders causing intractable intracranial hypertension. Usually, the distal catheter is inserted by performing a small laparotomy in the right paraumbilical, right subcostal, or median supraumbilical region. Despite advances in shunt technology and implant materials, a myriad of various complications continue to be reported, some most unusual.2 It is estimated that within 1 year of shunt placement 25%-40% of patients experience shunt complications. The risk reduces to 4%-5% annually thereafter. The mean survival of a shunt is approximately 5 years. 16 We present a case of CSF galactorrhea as the sole presenting symptom of a delayed proximal subcutaneous migration of the intraabdominal portion of a VP shunt. Case ReportHistory and Examination. A 46-year-old woman presented with a 6-year history of headaches and progressive visual loss diagnosed as idiopathic intracranial hypertension. All imaging failed to reveal a cause. The only observed risk factor was moderate obesity; the patient had a BMI of 31 kg/m 2 . After medical therapy failed and a left optic nerve sheath fenestration was unsuccessful, she was referred for CSF shunting as definitive treatment. She was scheduled for a VP shunt.Operation. An image-guided right frontal approach was chosen and the peritoneal cavity was entered via a standard right subcostal minilaparotomy by using a muscle-splitting technique through the rectus abdominus. The peritoneum was closed with a purse-string suture after a 90-cm peritoneal catheter connected to a PS Medical Strata II programmable valve (Medtronic, Inc.) was passed freely into the peritoneal cavity. The procedure was without complication and the patient's postoperative imaging revealed intraabdominal placement of the catheter.Postoperative Course. Six weeks after the shunt was implanted, the patient presented with painless, spontaneous clear fluid leakage from her right nipple; on compression it originated from a single duct in a jetlike fashion (Fig. 1). There was no palpable subcutaneous fluid collection along the course of the shunt catheter, and both breasts appeared symmetrical without deformity or sign of injury. She denied any recurrence of her previous symptoms to suggest a shunt malfunction. A sonogram was diagnostic for a subcutaneous fluid collection starting at the abdominal incision and extending to the inferior medial quadrant of the breast. A shunt series demonstrated the path of the distal catheter medial to the breast shadow and complete proximal migration of the peritoneal catheter into the subcutaneous tissues just at the level of the abdominal incision (Fig. 2).This migration was treated by repositioning of the distal end of the migrated catheter into the peritoneal cavity. In addition to a new peritoneal entry site, a subfascial tunnel under the anterior rectus sheat...

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“…According to them, upward tube displacement was due to abrupt release of the anchoring point formed by the abdominal scar around the catheter: it is stretched, and the shunt tube exits the abdominal cavity. CSF pouring through the shunt that continues functioning further eases the upward movement of the tube [5]. We agree to this being the mechanism for retrograde cutaneous migration of the peritoneal catheter into the neck.…”

Section: Introductionmentioning

confidence: 90%

“…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]. These complications can be encountered either in the immediate perioperative, postoperative or in the follow-up period.…”

Section: Introductionmentioning

confidence: 99%