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Atallah O, Badary A, Monib FA, Almealawy YF, Saleh A, Lioi F, Fathallah S, Sapkota A, Kundu M, Sanker V, Das JM. Ventriculoperitoneal shunt extrusion in pediatric patients, clinical patterns and therapeutic strategies: A scoping review. Surg Neurol Int 2024; 15:226. [PMID: 39108372 PMCID: PMC11301811 DOI: 10.25259/sni_215_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 05/01/2024] [Indexed: 01/31/2025] Open
Abstract
Background Ventriculoperitoneal shunts (VPSs) are frequently employed in neurosurgery to treat hydrocephalus, with a particular focus on pediatric patients. Although VPSs are commonly utilized, they are not exempt from difficulties, such as shunt extrusion. The main aim of this study is to enhance comprehension regarding the occurrence, causes contributing to, and consequences of VPS extrusion in pediatric patients. Methods A comprehensive search approach was implemented, including electronic databases, including PubMed, Google Scholar, and Scopus, to locate pertinent articles published between January 1950 and May 2023. The utilization of keywords such as "ventriculoperitoneal shunt" and "extrusion," "ventriculoperitoneal shunt" and "migration," and "ventriculoperitoneal shunt" and "perforation" was employed. Data on patient demographics, underlying diseases, origin of extrusion, presenting symptoms, treatment, and follow-up were gathered. Statistical studies were conducted to identify potential risk factors connected with the occurrence of shunt extrusion. Results A study analyzed 80 studies on 120 individuals with extruded VPS catheters. The majority of patients (55.8%) had symptoms such as cerebrospinal fluid leakage and irritation. Hydrocephalus was categorized into congenital (40%), obstructive (36.7%), and communicating (11.7%) groups. Catheter extrusion sites varied, with most from the anal or rectal site. Preoperative meningitis or peritonitis was present in 20% of patients. Treatments ranged from shunt removal to endoscopic third ventriculostomy, resulting in a 90% recovery rate, 1.7% mortality, and 5% follow-up loss. Conclusion Extrusion of the distal catheter in VPSs is a critical medical situation that necessitates urgent surgical intervention. The presence of an infection raises the likelihood of complications; hence, it is vital to promptly address the issue through the administration of antibiotics and the replacement of the shunt. Timely intervention enhances results.
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Affiliation(s)
- Oday Atallah
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Amr Badary
- Department of Neurosurgery, Klinikum Dessau, Dessau-Rosslau, Germany
| | - Fatma A. Monib
- House Officer, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Aalaa Saleh
- Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Francesco Lioi
- Department of Neurosurgery, Sapienza University of Rome, Rome, Italy
| | | | - Apil Sapkota
- Department of Psychiatry, University of Birmingham, Birmingham, United Kingdom
| | - Mrinmoy Kundu
- Department of Neurosurgery, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
| | - Vivek Sanker
- Department of Neurosurgery, Trivandrum Medical College, Trivandrum, Kerala, India
| | - Joe M. Das
- Department of Neurosurgery, Imperial College Healthcare National Health Services Trust, Charing Cross Hospital, London, United Kingdom
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Ghritlaharey RK. Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis. World J Clin Pediatr 2023; 12:331-349. [PMID: 38178931 PMCID: PMC10762601 DOI: 10.5409/wjcp.v12.i5.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/04/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt (VPS) catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion. AIM To identify the demographics, clinical presentation, clinical findings, and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter, clinically presented with or without trans-oral extrusion. METHODS An online search was performed for the extraction/retrieval of the published/ available literature pertaining to the above-mentioned VPS complication. Manuscripts were searched from PubMed, PMC (PubMed Central), ResearchGate, and Google Scholar databases using various terminology relating to the VPS complications. The first case of migration of a VPS catheter into the stomach was reported in the year 1980, and the data were retrieved from 1980 to December 2022. Cases were categorized into two groups; Group A: Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same, and Group B: Cases who had migration of the distal VPS catheter into the stomach, but presented without trans-oral extrusion. RESULTS A total of n = 46 cases (n = 27; 58.69% male, and n = 19; 41.3% females) were recruited for the systematic review. Group A included n = 32, and Group B n = 14 cases. Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the (n = 22) cases. Approximately sixty percent (n = 27) of them were children ≤ 5 years of age at the time of the diagnosis of the complication mentioned above. In seventy-two percent (n = 33) cases, this complication was detected within 24 mo after the VPS insertion/last shunt revision. Clinical diagnosis was evident for the entire group A cases. Various diagnostic modalities were used to confirm the diagnosis for Group B cases. Various surgical procedures were offered for the management of the complication in n = 43 cases of both Groups. In two instances, intra-gastric migration of the distal VPS catheter was detected during the autopsy. This review documented four deaths. CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups. It was more frequently reported in children, although also reported in adults and older people. A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without trans-oral extrusion.
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Affiliation(s)
- Rajendra Kumar Ghritlaharey
- Department of Paediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal 462001, Madhya Pradesh, India
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Morosanu C, Nicolae L. Gastrointestinal complications following ventriculoperitoneal shunt insertion for pediatric hydrocephalus. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_190_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Feeney V, Ansar N, Donaldson-Hugh B, Alalade AF. Transoral Protrusion of a Ventriculoperitoneal Catheter Caused by Jejunal Perforation in an Adult: Rare Case Report and Review of the Literature. World Neurosurg 2020; 137:200-205. [PMID: 32058122 DOI: 10.1016/j.wneu.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 01/31/2020] [Accepted: 02/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although several complications after ventriculoperitoneal shunting (VPS) have been reported, transoral protrusion of a peritoneal catheter is a rare event. In the few reported cases from the literature, it is more common in pediatric patients. This case report describes the first adult in the literature with a transoral VPS protrusion after jejunal perforation. CASE DESCRIPTION A 58-year-old man with posttraumatic hydrocephalus was noted with the distal tubing of the VPS protruding from his mouth after he vomited. Radiologic imaging showed jejunal perforation of the distal part of the VPS. The VPS was initially externalized, and then removed. The patient remained stable. CONCLUSIONS We present a rare case of transoral protrusion of a peritoneal catheter 11 months after a VPS procedure and review of the literature through this article.
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Affiliation(s)
- Vincent Feeney
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
| | - Naufel Ansar
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom
| | | | - Andrew F Alalade
- Department of Neurosurgery, Royal Preston Hospital, Preston, United Kingdom.
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Al Fauzi A, Suryaningtyas W, Wahyuhadi J, Parenrengi MA, Turchan A, Wijaya MC, Jonatan M, Mahyudanil, Setyono H. Upward migration and peroral extrusion of a peritoneal shunt catheter: Case report and review of the literature. Surg Neurol Int 2017; 8:178. [PMID: 28868190 PMCID: PMC5569403 DOI: 10.4103/sni.sni_138_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022] Open
Abstract
Background: Various complications after ventriculoperitoneal (VP) shunt surgery have been reported, but peroral extrusion of peritoneal catheter is an extremely rare complication, and only 20 cases have been reported since 1987. The pathophysiology still remains unclear and the management is challenging. Case Description: A 5-year-old boy presented with a catheter coming out of his mouth. The boy had a posterior fossa tumor surgery and had VP shunt insertion 1 year earlier. Clinical signs and imaging studies showed that the distal end of the catheter had perforated the gaster and migrated upward and extruded through the mouth. Emergency removal of the shunt and proper treatment were done and he made uneventful recovery. Conclusion: Peroral extrusion of VP shunt is extremely rare. Clinicians should be aware of this complication. With early diagnosis and proper management, the prognosis for good recovery is excellent, with only two deaths being reported in the literature. Complication of shunt extrusion is difficult to avoid, but knowing the risk factors, pathophysiology and proper management will decrease the morbidity and mortality of such cases.
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Affiliation(s)
- Asra Al Fauzi
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Wihasto Suryaningtyas
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Joni Wahyuhadi
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - M Arifin Parenrengi
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Agus Turchan
- Department of Neurosurgery, Medical Faculty, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Maria C Wijaya
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Michael Jonatan
- Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya Neuroscience Institute, Surabaya, Indonesia
| | - Mahyudanil
- Department of Neurosurgery, H. Adam Malik General Hospital, Medan, Indonesia
| | - Hanis Setyono
- Department of Neurosurgery, Medical Faculty, Universitas Sebelas Maret, Dr. Moewardi General Hospital, Surakarta, Indonesia
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Allouh MZ, Al Barbarawi MM, Asfour HA, Said RS. Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A Comprehensive Analytical Review from an Anatomical Perspective. Clin Anat 2017. [PMID: 28622424 DOI: 10.1002/ca.22928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Mohammed Z Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Mohammed M Al Barbarawi
- Division of Neurosurgery, Department of Neurosciences, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Hasan A Asfour
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Raed S Said
- Department of Anatomy, Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
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Ricci C, Velimirovic BM, Fitzgerald TN. Case report of migration of 2 ventriculoperitoneal shunt catheters to the scrotum: Use of an inguinal incision for retrieval, diagnostic laparoscopy and hernia repair. Int J Surg Case Rep 2016; 29:219-222. [PMID: 27883967 PMCID: PMC5122702 DOI: 10.1016/j.ijscr.2016.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 11/27/2022] Open
Abstract
A ventriculoperitoneal shunt catheter migrated through an inguinal hernia into the scrotum. A single incision was used to for diagnostic laparoscopy, catheter removal and hernia repair. Prompt surgical removal of fractured shunt catheters is recommended to prevent organ injury. Backgroud Ventriculoperitoneal shunts are commonly used in the treatment of hydrocephalus, and catheter migration to various body sites has been reported. Pediatric and general surgeons are asked on occasion to assist with intraabdominal access for these shunts, particularly when there may be extensive adhesions or other complicating factors. Methods We describe a case in which an old shunt catheter was never removed from the abdomen, and it migrated through an inguinal hernia into the scrotum. The catheter became entangled and fibrosed to the testicle. A second and more recent shunt catheter was also in the scrotum. A single incision in the inguinal region was used to remove both shunt catheters, repair the inguinal hernia and perform diagnostic laparoscopy to assist in placing a new ventriculoperitoneal shunt. Results Prompt surgical removal is recommended for catheters remaining in the abdomen after ventriculoperitoneal shunt malfunction. These catheters may cause injury to the testicle, or possibly other intraabdominal organs. General or pediatric surgical consultation should be obtained for lost catheters or inguinal hernias. Conclusion In the case of an inguinal hernia containing a fractured shunt catheter, the hernia sac can be used to remove the catheter, repair the hernia and gain laparoscopic access to the abdomen to assist with shunt placement.
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Affiliation(s)
- Caesar Ricci
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA
| | | | - Tamara N Fitzgerald
- Department of Surgery, Paul L Foster School of Medicine, Texas Tech University, EI Paso, TX, USA.
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Ghritlaharey RK. Review of the Management of Peroral Extrusion of Ventriculoperitoneal Shunt Catheter. J Clin Diagn Res 2016; 10:PE01-PE06. [PMID: 28050444 PMCID: PMC5198397 DOI: 10.7860/jcdr/2016/23372.8920] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Peroral extrusion of peritoneal part of Ventriculoperitoneal Shunt (VPS) catheter is an extremely rare complication following VPS implantation. AIM To review the options available for the management of peroral extrusion of VPS catheter. MATERIALS AND METHODS PubMed, Medline, PMC (PubMed Central), Embase, Google scholar databases search was performed to retrieve the published/available data relating to the peroral extrusion of VPS catheter. The keywords employed were "peroral extrusion of ventriculoperitoneal shunt catheter", "transoral extrusion of ventriculoperitoneal shunt catheter", and "oral extrusion of ventriculoperitoneal shunt catheter". The maiden description of peroral extrusion of VPS catheter was reported in the year 1987, and the data relating to peroral extrusion of VPS were retrieved from that period to June 30, 2016, and those were available in English literature. RESULTS Twenty-two published manuscripts (n) were available on the topic relating to peroral extrusion of VPS catheter. All were cases and were included for the review. This review included n=10; 45.45% male and n=12; 54.54% female. All of them were reported in children below 12-year of the age, except two case reports in adult that occurred at the age of 27-year and 47-year, respectively. Overall, the mean age at the time of peroral extrusion of VPS catheter was 6.94 ± 10.87 years. The interval from VPS insertion or last shunt revision to the occurrence of peroral extrusion of VPS catheter ranged from 10-days to 10-year, with a mean of 20.31 ± 28.37 months. More than two-third (n=15; 68.18%) of the case occurred within one-year of VPS insertion/last shunt revision. Clinical diagnosis was obvious in all the cases due to peroral extrusion of VPS catheter. The site of perforation by the VPS catheter was stomach in 15, jejunum in 1, diaphragm/trachea in 1, while the site of bowel perforation was not mentioned in 5 cases. Surgical procedures opted by authors in order of frequency were: (a) removal of entire VPS catheter n=5; (b) removal of entire VPS catheter, and delayed re-VPS n=5; (c) removal of peritoneal catheter with or without External Ventricular Drainage (EVD), and revision of peritoneal catheter n=3; (d) removal of peritoneal catheter, with or without EVD, and VA shunt n=3; (e) removal of peritoneal catheter, EVD and delayed re-VPS n=2; (f) removal of entire VPS catheter, EVD and delayed re-VPS n=2; (g) removal of peritoneal catheter, EVD and others n=2. Two deaths are also reported during the management of peroral extrusion of VPS catheter. CONCLUSION Peroral extrusion of peritoneal part of VPS catheter is an extremely rare complication following VPS insertion, and most frequently observed in children, although also reported in adults. In more than two-third of the cases it occurred within one-year of the VPS placement or last shunts revision, so a close follow-up is a must during this period following VPS placement. Management of such a case depends upon many factors such as presence or absence of shunt tract infection, peritonitis, meningitis, and cerebro spinal fluid infection.
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Affiliation(s)
- Rajendra Kumar Ghritlaharey
- Professor and Head, Department of Pediatric Surgery, Gandhi Medical College and associated Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India
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