Foreign Body Granuloma Secondary to Ventriculo-Peritoneal Shunt: A Rare Scenario with a New Insight

Abstract

Ventriculo-peritoneal shunts are used extensively for the management of hydrocephalus and frequently present with complications such as shunt blockage and infection. Cerebrospinal fluid (CSF) eosinophilia and allergic responses to the shunt itself are rare, poorly understood but increasingly recognised complications. Here, the authors describe a child who required multiple shunt revision surgeries due to extensive scalp tenderness overlying the shunt tubing and persistent severe headaches despite having a normal working shunt and no CSF infection or eosinophilia. Histological investigation of excised tissue during the last shunt revision demonstrated fibrosis with scar tissue and chronic inflammatory infiltrate with foreign body giant cells and few abortive granulomata. This was felt to represent a foreign body reaction to the shunt. A hypoallergenic ‘extracted' shunt was trialled (extracted Delta® valve and extracted ventricular and peritoneal catheters; Medtronic) and the child has had no further shunt revisions and is currently asymptomatic 1 year after the insertion.

Extrinsic Compression of the Gastric Wall by a Ventriculoperitoneal Shunt Catheter: Case Report and Literature Review

“…6 In addition, other postoperative complications, such as infection, cerebrospinal pseudocyst, perforations of abdominal organs and migration of distal catheter to the abdominal cavity, mediastinum or heart are also described. 1,3,4,6 The present is a report of a complication not often described in the literature, considering that studies 5,6 indicate that, in the event of migration, the catheter is restricted in up to 8.2% to the abdominal wall, with an association with the stomach being infrequent. However, when in contact with this organ, there is a higher incidence of gastric perforation, with protrusion of the catheter into the lumen of the organ, which often does not generate significant clinical changes.…”

“…2,4,5 The peritoneal cavity, however, is the most common drainage site, and the procedure is called ventriculoperitoneal (VP) shunt. [1][2][3][4][5] Nevertheless, complications are observed in the long term in some of these surgeries, and the most frequent are obstructions of the VP shunt catheter, formation of pseudocysts in the abdominal cavity, intestinal perforations, migration of the distal extremity, torsions, catheter breakage, infections, or even subdural hematoma. [2][3][4][5] The literature estimates that approximately 30% of patients undergoing this treatment will experience procedural failure, with patients free from other complications being restricted to 15% over 10 years.…”

“…A computed tomography (CT) scan of the skull was then performed, which revealed an important cerebral malformation, with areas of encephalomalacia in the right hemisphere, in addition to supratentorial ventriculomegaly (►Fig. 1).…”

“…Hydrocephalus is a condition in which there is an accumulation of cerebrospinal fluid (CSF) in the cranial cavity, whose pathophysiology is disorders related to its production, circulation or reabsorption, which enables its classification into obstructive and non-obstructive. 1 2 The understanding of the mechanisms that lead to this condition has been sought since the time of great scholars, such as Hippocrates, Galen and medieval Arab doctors. 3 Thus, the understanding of these processes enabled the development of procedures that would reduce the excess of CSF in the cranial box, such as the insertion of catheters inside the cerebral ventricular system.…”

“…2 4 5 The peritoneal cavity, however, is the most common drainage site, and the procedure is called ventriculoperitoneal (VP) shunt. 1 2 3 4 5 Nevertheless, complications are observed in the long term in some of these surgeries, and the most frequent are obstructions of the VP shunt catheter, formation of pseudocysts in the abdominal cavity, intestinal perforations, migration of the distal extremity, torsions, catheter breakage, infections, or even subdural hematoma. 2 3 4 5…”