Umbilical perforation: an unusual complication of a ventriculoperitoneal shunt

Eser, Olcay; Doğru, Ömer; Aslan, Adem; Kundak, Ahmet Afşin

doi:10.1007/s00381-006-0156-x

Cited by 13 publications

(18 citation statements)

References 4 publications

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“…89 In fact, the distal catheter may penetrate or migrate into multiple locations including the oral cavity, bladder, colon, umbilicus, gall bladder, and scrotum. 5,21,52,54,58 Methods of preventing such injury are debated but may include limiting distal catheter length and minimizing the angle at which the distal catheter is cut prior to insertion, though these techniques remain unproven in a systematic way.…”

Section: Intraabdominal Complicationsmentioning

confidence: 99%

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Wong¹,

Ziewacz

et al. 2012

FOC

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Object As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in CSF shunt surgery concerning the frequency of adverse events in practice, their patterns, and the state of knowledge regarding methods for their reduction. This review may also inform future and ongoing efforts for the advancement of neurosurgical quality. Methods The authors performed a PubMed search using search terms “cerebral shunt,” “cerebrospinal fluid shunt,” “CSF shunt,” “ventriculoperitoneal shunt,” “cerebral shunt AND complications,” “cerebrospinal fluid shunt AND complications,” “CSF shunt AND complications,” and “ventriculoperitoneal shunt AND complications.” Only papers that specifically discussed the relevant complication rates were included. Papers were chosen to be included to maximize the range of rates of occurrence for the adverse events reported. Results In this review of the neurosurgery literature, the reported rate of mechanical malfunction ranged from 8% to 64%. The use of programmable valves has increased but remains of unproven benefit even in randomized trials. Infection was the second most common complication, with the rate ranging from 3% to 12% of shunt operations. A meta-analysis that included 17 randomized controlled trials of perioperative antibiotic prophylaxis demonstrated a decrease in shunt infection by half (OR 0.51, 95% CI 0.36–0.73). Similarly, use of detailed protocols including perioperative antibiotics, skin preparation, and limitation of OR personnel and operative time, among other steps, were shown in uncontrolled studies to decrease shunt infection by more than half. Other adverse events included intraabdominal complications, with a reported incidence of 1% to 24%, intracerebral hemorrhage, reported to occur in 4% of cases, and perioperative epilepsy, with a reported association with shunt procedures ranging from 20% to 32%. Potential management strategies are reported but are largely without formal evaluation. Conclusions Surgery for CSF shunt placement or revision is associated with a high complication risk due primarily to mechanical issues and infection. Concerted efforts aimed at large-scale monitoring of neurosurgical complications and consistent quality improvement within these highlighted realms may significantly improve patient outcomes.

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Section: Intraabdominal Complicationsmentioning

confidence: 99%

Patterns in neurosurgical adverse events: cerebrospinal fluid shunt surgery

Wong¹,

Ziewacz

et al. 2012

FOC

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“…Among these, migration to the body compartments is common. Shunts migrated to the mediastinum (1,6), heart (4,9), abdominal wall (8,17) and scrotum (2,11) have been reported. Besides these, interesting examples of oral (3) and rectal (10,14,16) protrusions of the distal catheter have also been reported.…”

Section: Borcek Ao Et Al: Ventriculoperitoneal Shunt Complicationmentioning

confidence: 99%

An unusual ventriculoperitoneal shunt complication: spontaneous knot formation

Börcek

Çivi²,

Goleń³

et al. 2010

Turkish Neurosurgery

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This article aims to describe an extraordinary complication of a ventriculoperitoneal shunt system that formed a knot spontaneously and lead to a shunt malfunction. A 3-year-old male patient was operated due to posttraumatic hydrocephalus. After an uneventful follow-up period of 34 months, he presented with shunt malfunction. During the shunt revision surgery, the peritoneal catheter was found to form a loop over itself. There are various complications of ventriculoperitoneal shunt systems. Migration to body cavities is among the most interesting ones. This is the fifth report describing this rare complication. Hydrocephalic patients should be closely followed up after shunt surgery for various extraordinary complications. KeywOrds: V/P Shunt, Shunt Complication, Shunt Malfunction ÖZBu makale, kendi üzerine katlanarak bir düğüm oluşturup şant malfonksiyonuna neden olan ventriküloperitoneal şant sisteminin yol açtığı bu sıradışı bir komplikasyonu incelemektedir. Travma sonrasında gelişen hidrosefali nedeni ile opere edilen 3 yaşındaki erkek hasta 34 aylık sorunsuz bir takip süresi ardından şant malfonksiyonu ile başvurdu. Şant revizyonu sırasında peritoneal kateterin kendi üzerine katlanarak bir düğüm oluşturduğu gözlendi. Ventriküloperitoneal şant sistemlerine ait birçok farklı komplikasyon bildirilmiştir. Vücut boşluklarına migrasyon bu komplikasyonlardan en ilginç olanlar arasındadır. Bu makalede, sunulan vaka literatürdeki beşinci vakadır. Hidrosefalili hastalar şant cerrahisi sonrasında bu komplikasyonlar için yakın takipte tutulmalıdırlar.

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“…However, the changing dynamics of intra-abdominal causes such as the VP shunt may create defects in the umbilicus. When cases with the umbilical complication of VP shunt were investigated, some authors emphasized infection [1] , [6] , some were argued anatomical and congenital defects [7] , [8] . We think that the direct effect of CSF and VP shunt, such as chronic irrigation, silicon allergy, foreign body reaction, may cause sterile inflammation on the abdominal structures and this inflammation may soften tissue and cause CFS leakage and VP shunt extrusion.…”

Section: Discussionmentioning

confidence: 99%