ventriculoperitoneal_shunt_disconnection

Ventriculoperitoneal shunt disconnection

Mechanical shunt failure from shunt disconnection or shunt fracture is a significant cause of shunt failure 1).

Shunt catheter disconnection has been well described in the literature as a cause of shunt malfunction.

The distal component among the valve and the peritoneal catheter is the most probable site of disconnection 2).

Ventriculoperitoneal shunt disconnection risk factors.

Suspect with Undershunting.

see Shunt evaluation.

Ventriculoperitoneal shunt disconnection prevention.

Shunt catheters that migrate peritoneally bring the possibility of visceral injury, predominantly perforation of the bowel. These disconnected or fractured shunts can be revised by substituting or reconnecting the components, or by replacing the whole shunt system. In the modern era, the laparoscopic retrieval of migrated shunt catheters can be done safely, either as an emergency or an elective process 3).

A 5-year-old boy with a right-sided ventriculoperitoneal shunt presented with a 3-month history of progressively enlarging subperiosteal fluid collection in the scalp, which started in the right parietal region and had spread and extended across the midline to occupy both parietal regions. There were no changes in symptoms or signs from those observed 3 months previously. A CT scan confirmed the collection of fluid under the scalp over both parietal regions. The peritoneal catheter was found to be disconnected from the distal end of the functioning valve, which drained cerebrospinal fluid into the subperiosteal space. Distention of the parietal subperiosteal space led to stretching and tearing of the emissary veins. This resulted in the formation of a hydrohematocele. The spread of fluid to the opposite parietal region may be due to a disorganized and loose attachment of the periosteum to the widely separated sagittal suture 4).


An 8-year-old boy with a right VP shunt was referred because of progressive loss of consciousness in the morning. A CT scan of the head established moderate hydrocephalus. A shunt series presented a disconnection of the distal tube of the shunt as the distal part was free in the abdominal cavity. The patient experienced a complete shunt revision. The abdominal incision was revived and the tube removed from the abdominal cavity gently. The patient was discharged 72 h later 5).


1)
Erol FS, Ozturk S, Akgun B, Kaplan M. Ventriculoperitoneal shunt malfunction caused by fractures and disconnections over 10 years of follow-up. Childs Nerv Syst. 2017 Mar;33(3):475-481. doi: 10.1007/s00381-017-3342-0. Epub 2017 Jan 17. PMID: 28097382.
2)
Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, et al. (2007) Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int 23(6): 575-580.
3)
Vinchon M, Baroncini M, Laurent T, Patrick D (2006) Bowel perforation caused by peritoneal shunts catheters: diagnosis and treatment. Neurosurgery 58(1): 76-82.
4)
Choudhury AR. Cephalhydrohematocele due to catheter valve disconnection following ventriculoperitoneal shunting. Childs Nerv Syst. 1988 Dec;4(6):376-7. PubMed PMID: 3245948.
5)
Haddadi K, Qazvini HRG, Sahebi M (2017) Ventriculoperitoneal Shunt Disconnection Associated with Loss of Consciousness in a Child Patient: A Case Report and Review of Intra-Abdominal Complications of Vp Shunts. J Neurol Stroke 7(3): 00237. DOI: 10.15406/jnsk.2017.07.00237
  • ventriculoperitoneal_shunt_disconnection.txt
  • Last modified: 2021/04/10 13:05
  • by administrador