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abdominal_catheter_migration

Abdominal catheter migration

Can we really safely abandon a catheter into the peritoneal cavity? 1).

The most prevalent (occurring in 8.6% of shunt-treated patients) and morbid complications is distal shunt tip migration out of the abdomen, resulting in CSF collection in the anterior rectus space.

Is a well-known phenomenon, and intraabdominal shunt tubes have appeared in many inappropriate places.

Complications at the intraperitoneally (ip) lodging distal end of the shunt tube are reported to be from 10% to 30% 2) 3).

Typically, one encounters preperitoneal or ip pseudocysts, shunt infection, shunt dislocation, or disconnection 4) 5) 6).

Also, migration of the abdominal end has been reported on frequently 7) 8) 9) 10) 11) 12) 13) 14).

The most frequently encountered abdominal complication following VP shunting in a group of patients was shunt disconnection with intraperitoneal distal catheter migration. It occurred in eight of the seventeen patients with abdominal complication (47.05%) 15)

It can cause a rise in intracranial pressure as a result of obstruction as well as infection of the central nervous system from ascending infection. Therefore, prompt treatment is warranted to avert a life-threatening condition.

Once shunt dysfunction or abdominal symptoms occur, a thorough physical examination is warranted, especially because VP-shunt–bearing patients frequently are not capable of adequate verbal expression. Neurological symptoms of raised intracranial pressure, such as headache, nausea, vomiting, impaired gait, nuchal rigidity, seizures, and others, in combination with abdominal pain, abdominal distention, abdominal wall rigidity, or local irritation, merit further evaluation by imaging or other diagnostic procedures, such as CT abdomen, endoscopy, or even laparoscopy and should lead to diagnosis. Also, simple X-ray images cannot reproduce an intraabdominal malposition safely. Therefore, the number of such cases may be underestimated. In this case, the incorrect position of the catheter was sufficiently diagnosed by cross-sectional imaging.

Additionally, the valve itself or an abdominal fluid accumulation can be tapped for cell counts and microbiological specimens of possibly infected CSF. Depending on whether the shunt tube is involved in, or surrounded by, infectious material, the system might be left in place after abdominal revision 16).

Despite initial doubts about abdominal CO2 insufflation with a certain pressure, as required for laparoscopic surgery, laparoscopy for abdominal procedures in the presence of a VP shunt has been reported to be feasible 17) , and should be the preferred approach 18) 19).

A VP shunt system virtually crosses interdisciplinary borders. Patients need an individual approach, depending on the kind of dysfunction. Close interdisciplinary management is mandatory for a favorable outcome. Endoscopic or laparoscopic procedures can be a trauma-minimizing means for diagnosis and treatment 20).

Scrotum

Case reports

2015

Distal migration of the peritoneal catheter and extrusion from the intact skin in an area unrelated to the surgical incision constitute a rare complication.

Oktay et al. report a 1-year-old patient with the extrusion of the peritoneal catheter from the intact skin in the right lumbar region 21).

2013

A 7-month-old infant, who had suffered from intraventricular hemorrhage at birth, was shunted for progressive hydrocephalus. The peritoneal catheter, connected to an 'ultra small, low pressure valve system' (Strata®; PS Medical,Gola, CA, USA) at the subgaleal space, was placed into the peritoneal cavity about 30 cm in length. The patient returned to the hospital due to scalp swelling 21 days after the surgery. Simple X-ray images revealed total upward migration and coiling of the peritoneal catheter around the valve. Possible mechanisms leading to proximal upward migration of a peritoneal catheter are discussed 22).

1)
Berte N, Karunna R, Joud A, Larmure O, Lemelle JL. Can we really safely abandon a catheter into the peritoneal cavity? Childs Nerv Syst. 2017 Aug 8. doi: 10.1007/s00381-017-3547-2. [Epub ahead of print] PubMed PMID: 28791451.
2)
Bryant MS, Bremer AM, Tepas JJ, 3rd, Mollitt DL, Nquyen TQ, Talbert JL. Abdominal complications of ventriculoperitoneal shunts. Case reports and review of the literature. Am Surg. 1988;54:50–55.
3)
Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurgery. 2007;61:557–562.
4)
Turner R, Chahlavi A, Rasmussen P, Brody F. Laparoscopic revision of a ventriculoperitoneal shunt. J Laparoendosc Adv Surg Tech A. 2004;14:310–312.
5)
Acharya R, Ramachandran CS, Singh S. Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A. 2001;11:167–170.
6) , 7) , 16)
Nfonsam V, Chand B, Rosenblatt S, Turner R, Luciano M. Laparoscopic management of distal ventriculoperitoneal shunt complications. Surg Endosc. 2008;22:1866–1870.
8)
Doh JW, Bae HG, Lee KS, Yun IG, Byun BJ. Hydrothorax from intrathoracic migration of a ventriculoperitoneal shunt catheter. Surg Neurol. 1995;43:340–343.
9)
Berkmann S, Schreiber V, Khamis A. Recurrent intrahepatic dislocation of ventriculoperitoneal shunt. Minim Invasive Neurosurg. 2011;54:83–86.
10)
Hermann EJ, Zimmermann M, Marquardt G. Ventriculoperitoneal shunt migration into the pulmonary artery. Acta Neurochir (Wien). 2009;151:647–652.
11) , 19)
Ghritlaharey RK, Budhwani KS, Shrivastava DK, et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int. 2007;23:575–580.
12)
Surchev J, Georgiev K, Enchev Y, Avramov R. Extremely rare complications in cerebrospinal fluid shunt operations. J Neurosurg Sci. 2002;46:100–102.
13)
Chu YT, Chuang HC, Lee HC, Cho DY. A ventriculoperitoneal shunt catheter wrapped around a right mammary prosthesis forming a pseudocyst. J Clin Neurosci. 2010;17:801–803.
14)
Berhouma M, Messerer M, Houissa S, Khaldi M. Transoral protrusion of a peritoneal catheter: a rare complication of ventriculoperitoneal shunt. Pediatr Neurosurg. 2008;44:169–171.
15)
Popa F, Grigorean VT, Onose G, Popescu M, Strambu V, Sandu AM. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt. J Med Life. 2009 Oct-Dec;2(4):426-36. PubMed PMID: 20108757; PubMed Central PMCID: PMC3019022.
17)
Collure DW, Bumpers HL, Luchette FA, Weaver WL, Hoover EL. Laparoscopic cholecystectomy in patients with ventriculoperitoneal (VP) shunts. Surg Endosc. 1995;9:409–410.
18)
Acharya R, Ramachandran CS, Singh S. Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery. J Laparoendosc Adv Surg Tech A. 2001;11:167–170. ((Nfonsam V, Chand B, Rosenblatt S, Turner R, Luciano M. Laparoscopic management of distal ventriculoperitoneal shunt complications. Surg Endosc. 2008;22:1866–1870.
20)
Knuth J, Detzner M, Heiss MM, Weber F, Bulian DR. Laparoscopy for a ventriculoperitoneal shunt tube dislocated into the colon. JSLS. 2013;17(4):675-8. doi: 10.4293/108680813×13794522666527. PubMed PMID: 24398218; PubMed Central PMCID: PMC3866080.
21)
Oktay K, Erkoc YS, Ethemoglu KB, Olguner SK, Sarac ME. Spontaneous Extrusion of Ventriculoperitoneal Shunt Catheter through the Right Lumbar Region: A Case Report and Review of the Literature. Pediatr Neurosurg. 2015 Oct 13. [Epub ahead of print] PubMed PMID: 26458143.
22)
Cho KR, Yeon JY, Shin HJ. Upward migration of a peritoneal catheter following ventriculoperitoneal shunt. J Korean Neurosurg Soc. 2013 Jun;53(6):383-5. doi: 10.3340/jkns.2013.53.6.383. Epub 2013 Jun 30. PubMed PMID: 24003378; PubMed Central PMCID: PMC3756136.
abdominal_catheter_migration.txt · Last modified: 2017/08/10 19:22 by administrador