Two unusual complications of ventriculoperitoneal shunts in the same infant

Nourisamie, Kourosh; Vyas, Pranav K.; Swanson, Kenneth

doi:10.1007/s002470100545

Cited by 15 publications

(11 citation statements)

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“…Migration of the shunt or its parts has been reported but usually it is the distal or the peritoneal catheter that migrates after breakage or disconnection into many locations such as the scalp, heart, anus/rectum, urethra, umbilicus, chest, pleural cavity, inguinal canal and scrotum [6]. An unusual complication through the knee was also described in a 10-month-old infant [7]. Complete or total migration of the shunt as a whole is very rare and few cases are described in the literature [8, 9].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Cerebrospinal Fluid Shunting Complications in a Nigerian Neurosurgery Programme

Komolafe¹,

Adeolu²,

Komolafe

2007

Pediatr Neurosurg

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Background/Aims: For a century since the first cerebrospinal fluid (CSF) shunt surgery, ventriculoperitoneal (VP) shunt insertion for the treatment of hydrocephalus has routinely been performed. A lot of common and rare complications following this procedure have been reported in 24–47% of the cases. The aim of this paper was to present our experience with the treatment of hydrocephalus in our centre and highlight our management of two unusual complications with the available resources. Methods: Retrospective clinical review. Results: A total of 86 patients with hydrocephalus were seen in our unit. There were 52 males and 34 females (male:female ratio 3:2). The age of the patients ranged from 1 day to 68 years. The majority of the patients (92%) were below 5 years of age. Sixty-five patients had shunting procedures [VP shunt: 62 (95.4%); endoscopic third ventriculostomy: 3 (4.6%)]. Of the 62 patients with VP shunts, 16 (25.8%) had complications while 2 of the 3 patients with endoscopic third ventriculostomies had complications. The complications following the VP shunts were CSF shunt sepsis (n = 12; 19.4%), abdominal complications (n = 3; 4.8%), subdural haematoma (n = 2; 3.2%) and scalp necrosis in 1 patient. Conclusion: VP shunt procedures have come to stay and will remain with us despite recent advances such as endoscopic third ventriculostomy. Care should be taken to prevent all complications whether common or rare by paying particular attention to patient selection, shunt selection and surgical details. The adaptation of local technology and justified use of limited facilities and resources can go a long way in the management of both common and rare complications in developing nations.

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Section: Discussionmentioning

confidence: 99%

Treatment of Cerebrospinal Fluid Shunting Complications in a Nigerian Neurosurgery Programme

Komolafe¹,

Adeolu²,

Komolafe

2007

Pediatr Neurosurg

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“…In their case report from the paediatric literature, Nourisamie and colleagues describe a case of VP shunt infection by S. marcescens in a 10-month-old girl being treated for hydrocephalus after the VP shunt tip had perforated the small bowel and migrated intraluminally. 7 In this report, however, we describe a case of VP shunt infection by S. marcescens in a 58-year-old woman with rheumatoid arthritis but no bowel perforation who presented with both an intraabdominal abscess and pleural effusion-two known complications of VP shunt placement.…”

Section: Introductionmentioning

confidence: 80%

“…9 Prior to this report, S. marcescens has been identified as a causative agent in late VP shunt infection only once. 7 Although the precise aetiology of abdominal pseudocyst (APC) formation in association with late-onset shunt infection is unknown and likely multifactorial, low-virulence organisms and alterations in host immune responses appear to play a role. 9,13 Interestingly, both of these observations are applicable in this case report as the offending agent was S. marcescens (a relatively low-virulence Gram-negative organism) and the patient had alterations in her immune system (as she was taking the immunosuppressive agent methotrexate).…”

Section: Discussionmentioning

confidence: 99%

Ventriculoperitoneal shunt infection due to Serratia marcescens

Bremer

Darouiche

2005

Journal of Infection

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“…VPS catheter protrusion have also been reported from umbilicus, gastrostomy wound, healed neck wound, knee, mouth, etc. [19][20][21][22][23][24][25]. Metastases of a brain tumor via VPS to the abdomen have also been reported in literature [26,27].…”

Section: Discussionmentioning

confidence: 96%

Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children

et al. 2007

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Ventriculo-peritoneal (VP) shunting used in the treatment for hydrocephalus is associated with several complications. Mechanical failure of shunt is the commonest complication of all. Visceral/bowel perforation is an unusual but serious complication of VP shunting. This article reports our experience in the management of ten children who had VP Shunt catheter protrusion from anus. This is a retrospective study of ten patients who had VP shunt catheter protrusion from anus, admitted in the department of paediatric surgery between Jan 1996 and Dec 2005. The records of above ten cases were reviewed for their clinical presentation and management, etc. We had performed 398 VP shunt operations in the last 10 years. Two hundred and seventy one (68.09%) VP Shunts were done for congenital hydrocephalus of which 164 were done in infancy/neonatal period and 107 VP shunts were done in the age group of >1-12 years. One hundred and twenty-seven (31.90%) VP shunt operations were done for patients who had hydrocephalus as a complication following tubercular meningitis (TBM). Out of 398 VP shunts, ten patients (2.51%) had protrusion of the distal end of peritoneal catheter from anus without causing/leading to peritonitis. We observed a 08.29% mortality of all VP shunt operations. Protrusion of VP shunt catheter per rectum can occur without producing peritonitis. Formal exploration and localization of entry of VP shunt catheter in bowel is not mandatory. Mini laparotomy and revision of peritoneal part of shunt can be done if there is no shunt infection.

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Two unusual complications of ventriculoperitoneal shunts in the same infant

Abstract: Ventriculoperitoneal shunts have been associated with many different complications. We describe two rare complications in a 10-month-old girl. To the best of our knowledge, protrusion of ventriculoperitoneal shunt through the knee has not been reported before.

Cited by 15 publications

References 0 publications

Treatment of Cerebrospinal Fluid Shunting Complications in a Nigerian Neurosurgery Programme

Treatment of Cerebrospinal Fluid Shunting Complications in a Nigerian Neurosurgery Programme

Ventriculoperitoneal shunt infection due to Serratia marcescens

Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children

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