DOI: http://dx.doi.org/10.18203/2349-2902.isj20214472

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

Rajendra K. Ghritlaharey

Abstract


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.  


Keywords


Children, Complication, Extrusion, Hydrocephalus, Infants, Umbilicus, Ventriculoperitoneal shunt, Ventriculoperitoneal shunt revision

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References


Notarianni C, Vannemreddy P, Caldito G, Bollam P, Wylen E, Willis B et al. Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. J Neurosurg Pediatr. 2009;4:547-52.

Kumar P, Pandey S, Bhakal N, Shrivastava S, Gupta LN, Jha RP. A retrospective study on ventriculoperitoneal shunt complications in a tertiary care centre. Ind J Neurosurg. 2020;9:170-4.

Catapano JS, Mezher AW, Wang DJ, Whiting AC, Mooney MA, Bohl MA, et al. Laparoscopic-assisted ventriculoperitoneal shunt placement and reduction in operative time and total hospital charges. World Neurosurg. 2020;135:e623-8.

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int. 2007;23:575-80.

Ghritlaharey RK. Review of the management of peroral extrusion of ventriculoperitoneal shunt catheter. J Clin Diagn Res. 2016;10:PE01-6.

Miranda ME, de Sousa MB, Tatsuo ES, Quites LV, Giannetti AV. Bladder perforation by ventriculoperitoneal shunt. Childs Nerv Syst. 2016;32:2321-26.

Ghritlaharey RK. Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021. Int J Res Med Sci. 2021;9:3416-23.

Panigrahi S, Mishra SS, Das S, Tripathy L, Pattajoshi AS. Spontaneous extrusion of peritoneal catheter of ventriculoperitoneal shunt through the intact abdominal wall: Report of two cases. J Pediatr Neurosci. 2012;7:228-30.

Harischandra LS, Sharma A, Chatterjee S. Shunt migration in ventriculoperitoneal shunting: A comprehensive review of literature. Neurol India. 2019;67:85-99.

Allouh MZ, Al Barbarawi MM, Asfour HA, Said RS. Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus: A comprehensive analytical review from an anatomical perspective. Clin Anat. 2017;30:821-30.

Adeloye A. Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. Case report. J Neurosurg. 1973;38:758-60.

Takahashi J, Makita Y, Nabeshima S, Tei T, Keyaki A, Miyamoto Y. Spontaneous extrusion of peritoneal tubes after ventriculoperitoneal shunting. Report of two cases. Neurol Med Chir (Tokyo). 1988;28:808-11.

Das PC, Radhakrishna K, Rao PLNG. Spontaneous extrusion of a peritoneal tube through the umbilicus: an unusual complication of ventriculo-peritoneal shunt for hydrocephalus. Pediatr Surg Int. 1992;7:209-10.

Saeedy-Boroujeni HR. Photoclinic diagnosis: Protrusion of peritoneal part of VP shunt catheter from umbilicus. Arch Irn Med. 2002;5:61-2.

Wani AA, Ramzan A, Wani MA. Protrusion of a peritoneal catheter through the umbilicus: an unusual complication of a ventriculoperitoneal shunt. Pediatr Surg Int. 2002;18:171-2.

Silav G, Tun K, Dolgun H, Unlu A, Selcuki M. The spontaneous umbilical perforation of the distal end of ventriculoperitoneal shunt. Neurochirurgie. 2002;48:128-30.

de Aquino HB, Carelli EF, Borges Neto AG. Pereira CU. Nonfunctional abdominal complications of the distal catheter on the treatment of hydrocephalus: an inflammatory hypothesis? Experience with six cases. Childs Nerv Syst. 2006;22:1225-30.

Eser O, Dogru O, Aslan A, Kundak AA. Umbilical perforation: an unusual complication of a ventriculoperitoneal shunt. Childs Nerv Syst. 2006;22:1509-10.

Kanojia R, Sinha SK, Rawat J, Wakhlu A, Kureel S, Tandon R. Unusual ventriculoperitoneal shunt extrusion: Experience with 5 cases and review of the literature. Pediatr Neurosurg. 2008;44:49-51.

Kella N, Rathi PK, Qureshi MA. Umbilical perforation: A rare complication of ventriculoperitoneal shunt. J Coll Physicians Surg Pak. 2008;18:644-5.

Sarkar D, Sarkar S. Ventriculoperitoneal shunt catheter migration through umbilicus - A rare complication. Pediatr Oncall J. 2010;7:20-1.

Kumar B, Sharma SB, Singh DK. Extrusion of ventriculo-peritoneal shunt catheter. Indian J Pediatr. 2010;77:336.

Ardalan M, Rafati HA, Nejat F, EL Khashab M. Umbilical hernia and ventriculoperitoneal shunt complications. Iran J Pediatr. 2011;20:127-8.

Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. Ventriculoperitoneal shunt complications needing shunt revision in children: a review of 5 years of experience with 48 revisions. Afr J Paediatr Surg. 2012;9:32-9.

Kundal VK, Gajdhar M, Sharma C, Agrawal D, Kundal R. Wandering distal end of ventriculo-peritoneal shunt: Our experience with five cases and review of literature. J Nepal Paediatr Soc. 2012;32:266-9.

Ogungbo B, Olawoye O, Akudo JU, Ebang P. Management of an extruded ventriculoperitoneal catheter coming through the umbilicus. Niger J Gen Pract. 2016;14:14-6.

Gadjradj PS, Willemsz L, Spoor JK. Spontaneous externalization of a ventriculoperitoneal shunt tip through the navel. Br J Neurosurg. 2020;24:1-2.

Xia Y, He F, Ren Z, Wang C. Extrusion of the distal catheter from the umbilicus: A case report of a rare complication after ventriculoperitoneal shunt and its management. Front Pediatr. 2020;8:228.

Calgaro S, Colangelo AC, Otchirov S, Pizzol D, Antunes M. Failed ventriculoperitoneal shunt as treatment of infantile hydrocephalus. World Journal of Pediatric Surgery. 2020;3:e000123.

Pant N, Singh S, Singh G, Kumar A, Rai RK, Rawat J et al. The wandering ventriculoperitoneal shunt and the scope of its salvage. Childs Nerv Syst. 2021;37:2613-8.

Al-Akayleh A, Shurbage A. Management of unusual ventriculoperitoneal shunt complications. Journal of the Royal Medical Services (JRMS). 2009;16:55-60.

Agarwal N, Shukla RM, Agarwal D, Gupta K, Luthra R, Gupta J et al. Pediatric ventriculoperitoneal shunts and their complications: An analysis. J Indian Assoc Pediatr Surg. 2017;22:155-7.

Ezzat AAM, Soliman MAR, Hasanain AA, Thabit MA, Elshitany H, Kandel H et al. Migration of the distal catheter of ventriculoperitoneal shunts in pediatric age group: Case series. World Neurosurg. 2018;119:e131-7.

Thiong'o GM, Luzzio C, Albright AL. Ventriculoperitoneal shunt perforations of the gastrointestinal tract. J Neurosurg Pediatr. 2015;16:36-41.

Badri M, Gader G, Belkahla G, Kallel J, Zammel I. Transoral migration of the inferior end of a ventriculoperitoneal shunt: A case report with literature review. Neurochirurgie. 2018;64:203-5.

Feeney V, Ansar N, Donaldson-Hugh B, Alalade AF. Transoral protrusion of a ventriculoperitoneal catheter caused by jejunal perforation in an adult: Rare case report and review of the literature. World Neurosurg. 2020;137:200-5.

Faheem M, Jaiswal M, Prajapati HP, Kumar R, Saba Nu, Ojha BK. Unusual complications of ventriculoperitoneal shunt surgery: Tertiary care experience. J Pediatr Neurosci. Available at: https://www.pediatricneurosciences.com/preprintarticle.asp?id=320385. Accessed on 31 October 2021.

Sinha VD, Bhardwaj S, Purohit D, Chopra S. Unusual extrusion of distal end of ventriculoperitoneal shunt: Case series with literature review. Interdisciplinary Neurosurgery. 2021;24:101026.

Antunes AC, Ribeiro TR. Spontaneous umbilical fistula from ventriculoperitoneal shunt drainage. Report of two cases. J Neurosurg. 1975;43:481-2.

Takase T, Tane K, Suzuki T, Inoue T, Fumoto Y. Spontaneous umbilical fistula as a complication of ventriculo-peritoneal shunt: case report. No Shinkei Geka. 2005;33:725-9.

Dolas I, Apaydin HO, Yucetas SC, Ucar MD, Kilinc S, Ucler N. Cerebrospinal fluid leakage from the umbilicus: Case report and literature review. Int J Surg Case Rep. 2016;20: 60-2.

Vankipuram S, Jaiswal S, Jaiswal M, Bajaj A, Chandra A, Ojha BK. Spontaneous umbilical CSF fistula due to migration of the peritoneal end of VP shunt: A case report and review of pathogenesis. J Pediatr Neurosci. 2017;12:285-7.

Yeola (Pate) M, Singh K. Ventriculoperitoneal shunt presenting as umbilical CSF fistula. J Family Med Prim Care. 2020;9:6276-8.

Hegazy AA. Anatomy and embryology of umbilicus in newborns: a review and clinical correlations. Front Med. 2016;10:271-7.

Das A. Umbilical lesions: A cluster of known unknowns and unknown unknowns. Cureus. 2019;11:e5309.