J Korean Neurosurg Soc.  2013 Jun;53(6):383-385. 10.3340/jkns.2013.53.6.383.

Upward Migration of a Peritoneal Catheter Following Ventriculoperitoneal Shunt

• Cho KR
• Yeon JY
• Shin HJ

• KMID: 2190831
• DOI: http://doi.org/10.3340/jkns.2013.53.6.383

Abstract

We present an unusual case of peritoneal catheter migration following a ventriculoperitoneal shunt operation. 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(R); PS Medical,Gola, CA, USA) at the subgaleal space, was placed into the peritoneal cavity about 30 cm in length. The patient returned to our 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.

Keyword

Ventriculoperitoneal shunt; Migration; Distal catheter; Windlass effect

MeSH Terms

Catheters
Hemorrhage
Humans
Hydrocephalus
Infant
Parturition
Peritoneal Cavity
Scalp
Ventriculoperitoneal Shunt

Figure

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  Fig. 1 Hydrocephalus and associated encephalomacia in the right frontal lobe is seen on a brain computed tomography scan.

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  Fig. 2 A : Total migration of the distal catheter, which is coiled under the scalp to forma subgaleal swelling. B : No shunt catheter is seen on the plain abdomen X-ray.

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  Fig. 3 A : Postoperative computed tomography (CT) scan of the initial ventriculoperitoneal shunt surgery. Ventricle size decreased with the shunt tip placed properly in the ventricle horn. Subdural hygroma and encephalomatic lesions are seen together. B : CT taken before revision surgery. Ventricle size decreased compared to that on the previous CT scan. The distal catheter has migrated upward and coiled around the shunt reservoir.

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  Fig. 4 Shunt reservoir is filled with an old hematoma, and the catheter hole is plugged with blood clots.

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