Spontaneous umbilical CSF fistula due to migration of the peritoneal end of VP shunt: A case report and review of pathogenesis

Vankipuram, Siddharth; Jaiswal, Somil; Jaiswal, Manish; Bajaj, Ankur; Chandra, Anil; Ojha, Bal Krishna

doi:10.4103/jpn.jpn_47_17

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…39 CSF umbilical fistula is more frequent than that of the trans-umbilical extrusion of the distal VPS catheter. [40][41][42][43]…”

Section: Discussionmentioning

confidence: 99%

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Ghritlaharey

2021

Int Surg J

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Trans-umbilical extrusion of the distal ventriculoperitoneal shunt catheter is a rare complication of the VPS insertion. The objectives of this review were to analyze various variables like the age, sex, indication for VPS insertion, clinical presentation, the operative therapy offered for the management, and outcome of the cases published/managed for the trans-umbilical extrusion of the distal VPS shunt catheter. In 1973, the maiden case of trans-umbilical extrusion of the distal VPS catheter was published. Literature/case reports were retrieved from 1973 to October 31, 2021. A total of n=24 (12 males, 12 females) cases were recruited for this systematic review. All of them were children below the age of 13-years. In four-fifths (n=19) of children, the initial VPS catheter was inserted during the first 6-months of life. The median age of children at the time of diagnosis of the above-described VPS complication was 7.5 (42.21 SD) months, and it ranged from 2 months to 13 years of age. The median interval from the initial VPS insertion/last VPS revision to the diagnosis of complication was 4 (24.77 SD) months, and it ranged from 3 weeks to 8 years. The main complaint was the extrusion of the distal VPS catheter through the umbilicus. Surgical procedures performed for the management were (a) removal of the entire VPS catheter n=15, (b) removal of distal/part of distal VPS catheter n=5, and (C) others n=2. For VPS catheter revision; delayed re-VPS insertion was performed in n=10, immediate revision of the distal VPS catheter in n=3, and others. Three (12.5%) children died during the postoperative and follow-up period. The distal VPS catheter extrusion through the umbilicus is a rare complication of VPS insertion, and it occurred exclusively in children. In 70% (n=17) of children, it was documented ≤6 months afterward of the VPS insertion. Delayed re-VPS catheter insertion was preferred for 40% of the children for VPS revision procedures.

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“…39 CSF umbilical fistula is more frequent than that of the trans-umbilical extrusion of the distal VPS catheter. [40][41][42][43]…”

Section: Discussionmentioning

confidence: 99%

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Ghritlaharey

2021

Int Surg J

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“…The distal ends of VP shunts have been shown to migrate into various adjacent regions, including the thorax, heart, pulmonary artery, liver, colon, bowel, stomach, gallbladder, urinary bladder, anus, breast, scrotum, and vagina 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16. Various fistulas may result from VP shunt migration: umbilical CSF fistulas, enterocutaneous fistulas, and bronchopleural fistulas 9 , 17, 18, 19. Lumboperitoneal shunts may also migrate into the thorax and bronchus 20 .…”

Section: Discussion Resume Herementioning

confidence: 99%

Shunt-Bronchial Fistula with Coughing Up and Swallowing of Cerebrospinal Fluid: Rare Complication of Ventriculopleural Shunt

Katsevman

Harron

Bhatia

2020

World Neurosurgery: X

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BackgroundErosion of the distal catheter into lung parenchyma is an extremely rare complication of ventriculopleural shunt placement.Case DescriptionWe report a 51-year-old woman with a history of parasagittal meningioma invading the sagittal sinus who presented with recurrent pneumonia after placement of a ventriculopleural shunt. A nuclear study revealed accumulation of radiotracer material sequentially in the right hemithorax, trachea, mainstem bronchi, stomach, and bowel. The ventriculopleural shunt had eroded into the patient's lung parenchyma, with the effect of cerebrospinal fluid draining into the respiratory system and then being coughed up and swallowed into the gastrointestinal system.ConclusionSurgeons should be aware of the potential complication of a ventriculopleural shunt eroding through the lung parenchyma to cause a shunt-bronchial fistula with persistent coughing and recurrent pneumonias. Shuntogram nuclear imaging may be useful in the diagnosis of the complication.

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Ventriculoperitoneal shunt extrusion in pediatric patients, clinical patterns and therapeutic strategies: A scoping review

Atallah,

Badary,

Monib

et al. 2024

Surgical Neurology International

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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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Spontaneous umbilical CSF fistula due to migration of the peritoneal end of VP shunt: A case report and review of pathogenesis

Cited by 5 publications

References 8 publications

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Extrusion of the distal ventriculoperitoneal shunt catheter through the umbilicus: a systematic literature review from 1973 to 2021

Shunt-Bronchial Fistula with Coughing Up and Swallowing of Cerebrospinal Fluid: Rare Complication of Ventriculopleural Shunt

Ventriculoperitoneal shunt extrusion in pediatric patients, clinical patterns and therapeutic strategies: A scoping review

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