Ventriculoperitoneal Shunt Disconnection, Shunt Migration, and Silent Bowel Perforation in a 10-Year-Old Boy

Abstract

A 10-year-old boy was admitted with chest wall infection around the implanted ventriculoperitoneal shunt (VPS) catheter of 5 days. He had received a right-sided, medium pressure, whole-length VPS for hydrocephalus, following tubercular meningitis at the age of 3 years. Seven years, 9 months following VPS implantation, he was admitted with shunt tract infection at the chest area for 5 days. He had neither fever nor features of meningitis, raised intracranial pressure, or peritonitis. His clinical examination and radiological investigations revealed that the VPS catheter was disconnected at the cranial site, and it was migrated downward up to the upper chest. He was managed well with the removal of the entire VPS catheter. The removed peritoneal catheter along with the shunt chamber was loaded with fecal matter and was presumed that the peritoneal catheter was within the colon. His postoperative recovery was excellent. This is a rare case of VPS catheter disconnection, shunt migration, and silent bowel perforation by peritoneal catheter, and all the above-mentioned complications were detected in a child at the same time and were managed well with the removal of the entire VPS catheter.

Acute traumatic subdural effusion with hemorrhage in children under 3 years of age： a study of clinical characteristics and treatment strategy

“…In addition, In addition, there was a high rate of infection with percutaneous subdural puncture (25%) [34]. 0-12% of patients recurred after SPS and 8-36% of cases had postoperative complications [35][36][37][38]. Previous reports had indicated that 38-93% of cases require removal of the shunt after SPS and the burr-hole craniotomy performed had a higher rate of single operation success than SPS [32,38].…”

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

“…[33] Clinical presentation SCMPA is a rarer cause of cardiopulmonary shunt migration, where the catheter migrates to the pulmonary vasculature. [7,11,18,19,36] Patients with SCMPA usually develop signs and symptoms of increased ICP, including headaches, mental status changes, focal neurological deficits, and vomiting. In contrast, SCMPA patients with concurrent arterial thrombosis usually present with the right heart strain symptoms, such as, dyspnea, chest pain, exertion, and coughing in the emergency setting with signs of respiratory failure.…”

“…[7] VP shunt complications include catheter obstruction, infection, system disconnection, hardware failure, and pseudocyst formation. [11,31] Less commonly, VP shunt catheters may migrate into ectopic sites, including the bowels, bladder, abdominal wall, thoracic cavity, and cardiovascular system. [18] Distal VP shunt catheter migration into the pulmonary artery (SCMPA) with concurrent large vessel thrombosis is an extremely rare occurrence.…”

Techniques for management and avoidance of ventriculoatrial shunt disconnection: illustrative cases

“…One of the issues that can lead to distal catheter disconnection from a straight connector is repeated cervical motion. 4 The downward and shearing forces create mechanical stress that, over time, lead to degradation in the structural integrity of the shunt. 5 Angular forces applied at the proximal end of the shunt create a significant amount of tension that is communicated to the straight connector.…”