Late onset scrotal migration of the distal catheter of a ventriculoperitoneal shunt in a 4-year-old male with post meningitic hydrocephalus - a case report and review of literature

Sarangi, Gouri Sankar; Mohanty, Supriya; Rout, Suman Saurav

doi:10.18203/2349-2902.isj20160266

Cited by 5 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[1][2][3][4][5] Distal catheter migration, although rare, has been reported at many sites, including the thoracic and abdominal cavities and their occupying organs (lungs, liver, bowel), the intraabdominal wall, bladder, scrotum, vagina, and even the knee. 6,7 Spontaneous bowel perforation is rare (0.01% to 0.7% of VPS complications) but carries a high mortality rate of approximately 15% secondary to intraabdominal and/or intracranial infections. [1][2][3][4][5][6][7] Interestingly, >40% of abdominal migrations are asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Perioperative Management for Rectal Migration of a Ventriculoperitoneal Shunt

Cardinale

Carrillo

Colón

2020

TOJ

View full text Add to dashboard Cite

Background: While ventriculoperitoneal shunt (VPS) is the most commonly performed surgical procedure for treating hydrocephalus, complications following shunt placement are associated with a high mortality rate. Preoperative medical optimization and surgery are the primary means of correcting shunt migration. We present the case of an 11-week-old patient who underwent emergent surgical intervention for transrectal VPS migration and associated infection. Case Report: An 11-week-old female presented with VPS tubing protruding from her rectum. The patient had a history of grade III intraventricular hemorrhage complicated by hydrocephalus status post VPS placement at age 3 weeks. Shunt tap demonstrated gross infection, and she was started prophylactically on broad-spectrum antibiotics. She was taken emergently to the operating room (OR) for VPS externalization and exploratory minilaparotomy. VPS tubing was removed, and the patient was transferred to the pediatric intensive care unit for postoperative management. Cultures confirmed methicillinresistant Staphylococcus aureus, and the patient was treated according to infectious disease recommendations. On postoperative day (POD) 5, the patient had a full component VPS replacement. On POD 23, computed tomography scan of the head obtained for lethargy demonstrated a new midline shift, and she was returned to the OR for another VPS replacement. A small abscess was discovered and drained; postoperative cerebrospinal fluid laboratory values normalized after drainage. Once the infectious process cleared, the VPS was internalized on POD 33, and the patient was discharged home on POD 35. Conclusion: Few case reports detail the appropriate anesthetic considerations for cases of VPS migration. This report describes shunt migration pathophysiology and patient assessment with a focus on anesthetic preparation and management for this rare complication.

show abstract

Section: Discussionmentioning

confidence: 99%

“…6,7 Spontaneous bowel perforation is rare (0.01% to 0.7% of VPS complications) but carries a high mortality rate of approximately 15% secondary to intraabdominal and/or intracranial infections. [1][2][3][4][5][6][7] Interestingly, >40% of abdominal migrations are asymptomatic. 8 The etiology of VPS bowel perforation is largely unknown.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Management for Rectal Migration of a Ventriculoperitoneal Shunt

Cardinale

Carrillo

Colón

2020

TOJ

View full text Add to dashboard Cite

show abstract

“…It could be established as patent at 50-60% of 1-year olds and 40% for children between ages 2-16 years [6]. Increased abdominal pressure following shunt insertion may prevent obliteration of the Processus vaginalis and facilitates migration of the VP shunt into the scrotum [2]. Smaller size of peritoneal cavity in infancy compared with older children could be another etiologic factor for VP shunt migration to Processus vaginalis [7].…”

Section: Discussionmentioning

confidence: 99%

Herniotomy Alone as Treatment for Scrotal Migration of Ventriculoperitoneal Shunt

Balamurugan¹

2019

JHNSS

View full text Add to dashboard Cite

show abstract

“…This proposed mechanism is supported by our results, which demonstrated a higher incidence of external migration in infants than other age groups. Normally, the processus vaginalis remains patent in 60–70% of infants during first three months of life (Sarangi et al, ). In addition, the constant CSF drainage into the peritoneal cavity after VPS placement can increase the intra‐abdominal pressure and prolong the patency of the processus vaginalis, which could increase the risk of external migration into the external genitalia.…”

Section: Discussionmentioning

confidence: 99%

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

et al. 2017

View full text Add to dashboard Cite

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.

show abstract

Late onset scrotal migration of the distal catheter of a ventriculoperitoneal shunt in a 4-year-old male with post meningitic hydrocephalus - a case report and review of literature

Cited by 5 publications

References 11 publications

Perioperative Management for Rectal Migration of a Ventriculoperitoneal Shunt

Perioperative Management for Rectal Migration of a Ventriculoperitoneal Shunt

Herniotomy Alone as Treatment for Scrotal Migration of Ventriculoperitoneal Shunt

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

Contact Info

Product

Resources

About