Spontaneous etrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus

Abstract

✓ This paper reports the spontaneous extrusion of the abdominal portion of a ventriculoperitoneal shunt through the umbilicus. Some of the possible predisposing factors are discussed.

Complications of Ventriculo-Peritoneal Shunting and a Critical Comparison of the Three-Piece and One-Piece Systems

“…Two of the complications of peritoneal shunting, extrusion [1,58] through skin and organ perforation [6,40,42,49,62,72,75] had al ready been identified as complications of jugulo-cardiac shunting [14,29,32], The third, ascites [13,61] or accumulation of CSF in cystic pockets within the abdominal cavity [18,23] may be broadly compared to the pericardial tamponade reported by Tsingoglou and Eckstein [73] unless this latter is considered a result of myocardial rupture. Volvulus in ventriculo-peritoneal shunting was reported by Sakoda et al [63] and inflam matory pseudotumor of the mesentery by Keen and Weitzner [35].…”

CSF Fistula through the Umbilicus following a Shunt Surgery: A Case Report and Literature Review

“…A thorough search of the medical literature reveals a report of 12 such cases [1,5,6,7,8,9,10] of which catheter protrusion through the umbilicus was seen in 3 [1, 8, 9]. Congenital hydrocephalus remains a common cause for CSF diversion surgery, especially among pediatric patients [1, 5, 7, 9].…”

“…Congenital hydrocephalus remains a common cause for CSF diversion surgery, especially among pediatric patients [1, 5, 7, 9]. Numerous reports have tried to explain the pathogenesis of such a complication, which includes anatomical weakness [1], umbilical abscess [8], persistent umbilical vein [6], perivisceritis [6] or persistent urachal remnant [10]. The present report adds another such case, with a re-visit to the embryological basis of the pathophysiology behind such a complication.…”

“…The common abdominal complications include spontaneous extrusion of the peritoneal catheter, obstruction due to fibrous encasement, shunt migration, infection and CSF fistulas [1, 2]. Rarely, hollow viscera perforation including the bowel [3] and bladder [3], leading to shunt tube extrusion through the vagina [3], oral cavity [4], anus [3], umbilicus [1] and abdominal wall [3], has been reported. We present the case of an infant with a CSF fistula developing from the umbilicus and discuss the various pathophysiological causes behind such a complication.…”

Unusual Complication of Ventriculoperitoneal Shunt: Anal Extrusion

“…Many abdominal complications have been described which include fibrous encasement of the peritoneal tip, blocking or kinking of the distal tube, slipping out through the surgical wound or migration of the shunt or its component parts into the various abdominal cavities [2]. Other complications are infection, CSF fistula, paralytic ileus in the immediate postoperative period, failure of peritoneal absorption of the diverted CSF, perforation of the bowel by the abdominal tube, development of hydrocele, appearance of a peritoneal cyst and spontaneous extrusion of the tube through the umbilicus [3,4]. We highlight an unusual complication of this procedure with two of our cases developing spontaneous extrusion of the lower end of the tube through the anal opening.…”