Cerebrospinal fluid shunt catheter extrusion through the mouth in a child: a case report with brief literature review

Authors

  • Rajendra K. Ghritlaharey Department of Pediatric Surgery, Gandhi Medical College and Associated, Kamla Nehru and Hamidia Hospitals, Bhopal, Madhya Pradesh, India https://orcid.org/0000-0003-0407-1810

DOI:

https://doi.org/10.18203/2349-2902.isj20241614

Keywords:

Case report, Children, Complication, Extrusion, Gastric perforation, Hydrocephalus

Abstract

Extrusion of the distal end of the cerebrospinal fluid (CSF) shunt catheter through the mouth is a rare complication of shunt surgery performed to treat hydrocephalus. A two-year-old girl had her first CSF shunt inserted when she was six months old to treat congenital hydrocephalus. The shunt became infected 2-months later and had to be removed. A few weeks later, a new CSF shunt was inserted on the left side. One year later, she presented with an extrusion of the distal end of the CSF shunt catheter through her mouth. However, she showed no symptoms or signs of peritonitis or meningitis. Her entire CSF shunt system on the left side required removal. A cranial magnetic resonance imaging (MRI) scan showed ventriculomegaly and a new CSF shunt catheter was implanted on the right side. She had an uneventful postoperative period and was doing well during the follow-up. Extrusion of the distal end of the CSF shunt catheter through the mouth is rare and more likely to occur in children, and clinicians need to be aware of such complications.

References

Greuter L, Ruf L, Guzman R, Soleman J. Open vs laparoscopic ventriculoperitoneal shunt placement in children: a systematic review and meta-analysis. Childs Nerv Syst. 2023;39(7):1895-902.

Naftel RP, Argo JL, Shannon CN, Taylor TH, Tubbs RS, Clements RH, et al. Laparoscopic vs open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. J Neurosurg. 2011;115(1):151-8.

Sanderfer VC, Arnold MR, Mulvaney GG, Wang H, McLanahan CS, Wait SD, et al. Outcomes of laparoscopic and open ventriculoperitoneal shunt placement. Am J Surg. 2024;227:123-6.

Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: a review. Interdisciplinary Neurosurg. 2018;13:66-70.

Busse LC, Dubinski D, Gessler F, Dinc N, Konczalla J, Czabanka M, et al. Retrospective comparison of long-term functionality and revision rate of two different shunt valves in pediatric and adult patients. Acta Neurochir (Wien). 2023;165(9):2541-9.

Merkler AE, Ch'ang J, Parker WE, Murthy SB, Kamel H. The Rate of Complications after Ventriculoperitoneal Shunt Surgery. World Neurosurg. 2017;98:654-8.

Harischandra LS, Sharma A, Chatterjee S. Shunt migration in ventriculoperitoneal shunting: A comprehensive review of literature. Neurol India. 2019;67(1):85-99.

Ghritlaharey RK. Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis. World J Clin Pediatr. 2023;12(5):331-49.

Riley DS, Barber MS, Kienle GS, Aronson JK, von Schoen-Angerer T, Tugwell P, et al. CARE guidelines for case reports: explanation and elaboration document. J Clin Epidemiol. 2017;89:218-35.

Ghritlaharey RK. Systematic literature review of the management of transanal extrusion of distal ventriculoperitoneal shunt catheter: 1966–2020. Med J DY Patil Vidyapeeth. 2022;15(5):629-59.

Ghritlaharey RK. Systematic review of migration of distal ventriculoperitoneal shunt catheter into the urinary bladder with or without per-urethral extrusion. Med J DY Patil Vidyapeeth. 2022;15(6):840-53.

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(11):3416-23.

Nishijima M, Ohyama H, Higuchi H. Gastric perforation in ventriculo-peritoneal shunt--a case report. No Shinkei Geka. 1980;8(7):679-83.

Griffith JA, DeFeo D. Peroral extrusion of a ventriculoperitoneal shunt catheter. Neurosurgery. 1987;21(2):259-61.

Chowdhury SI, Shirodkar A, Bala A, Shankar KB, Tanwar I. Peroral extrusion of ventriculoperitoneal shunt: an unusual complication with literature review. Int J Scientific Res. 2023;12(9):33-4.

Abdul Rahim H. Zwayed, Sreenivas AV, Shabana AM, Rraziek YA, Nasser A, Refaat BF, et al. Abnormal migration and extrusion of lower end of ventriculoperitoneal shunt into the mouth. MAR Neurol Neurosurg Psychol. 2023;7:4.

Fermin S, Fernández-Guerra RA, Sureda PJ. Extrusion of peritoneal catheter through the mouth. Childs Nerv Syst. 1996;12(9):553-5.

Tamlikha A, Shukri F, Zahari Z. Transoral migration of ventriculoperitoneal shunt: A rare presentation. GMJ. 2021;32:131-4.

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

Faheem M, Jaiswal M, Prajapati HP, Kumar R, Saba Nu, Ojha BK. Unusual complications of ventriculoperitoneal shunt surgery: Tertiary care experience. J Pediatr Neurosci. 2022;17(1):30-5.

Sikandar M, Sridhar R. A prospective study of ventriculoperitoneal shunt complications and identification of risk factors. Int J Acad Med Pharm. 2023;5(6):290-5.

Berhouma M, Messerer M, Houissa S, Khaldi M. Transoral protrusion of a peritoneal catheter: a rare complication of ventriculoperitoneal shunt. Pediatr Neurosurg. 2008;44(2):169-71.

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Published

2024-06-12

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Section

Case Reports