International journal of surgery case reports · 2025
Two rare complications of cerebrospinal fluid shunting: A rare case report from Syria.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Warda Hamza, Alhassan Hasan Mohamad, Kokash Mohammad, Alhamoud Yasser
Аннотация
INTRODUCTION: Hydrocephalus, characterized by an abnormal accumulation of cerebrospinal fluid in the brain's ventricles, is commonly treated with ventriculoperitoneal (VP) shunts. A rare complication of VP shunts is the formation of abdominal pseudocysts (APCs). Ventriculoatrial (VA) shunts are used when VP shunts are not feasible, but they can lead to rare complications, including catheter migration.
CASE PRESENTATION: We present a 17-year-old Arab female who underwent VP shunt placement for hydrocephalus. She developed a pelvic abscess, which was managed successfully. Subsequently, she developed an APC associated with the VP shunt. This led to a temporary shunt externalization followed by conversion to a VA shunt. The patient then experienced a rare complication of the VA shunt's distal catheter migration into the subcutaneous tissue of the anterior neck. Consequently, the VA shunt was switched back to a VP shunt.
DISCUSSION: VP shunts are associated with various complications, including obstruction, infection, and APCs. VA shunts also carry risks such as shunt malfunction and catheter migration. Atrial catheter migration can occur in a retrograde or anterograde direction, each with distinct clinical consequences. Our patient underwent multiple shunt revisions due to APC formation and distal catheter migration. Ultimately, her complications were effectively managed, leading to clinical stabilization.
CONCLUSION: Neurosurgeons should suspect abdominal pseudocysts in VP shunt patients presenting with abdominal or neurological symptoms and perform prompt imaging for diagnosis. Proper catheter length, careful vein selection, and precise surgical technique are key to preventing VA shunt migration. Awareness of rare complications is crucial for optimal management.
CASE PRESENTATION: We present a 17-year-old Arab female who underwent VP shunt placement for hydrocephalus. She developed a pelvic abscess, which was managed successfully. Subsequently, she developed an APC associated with the VP shunt. This led to a temporary shunt externalization followed by conversion to a VA shunt. The patient then experienced a rare complication of the VA shunt's distal catheter migration into the subcutaneous tissue of the anterior neck. Consequently, the VA shunt was switched back to a VP shunt.
DISCUSSION: VP shunts are associated with various complications, including obstruction, infection, and APCs. VA shunts also carry risks such as shunt malfunction and catheter migration. Atrial catheter migration can occur in a retrograde or anterograde direction, each with distinct clinical consequences. Our patient underwent multiple shunt revisions due to APC formation and distal catheter migration. Ultimately, her complications were effectively managed, leading to clinical stabilization.
CONCLUSION: Neurosurgeons should suspect abdominal pseudocysts in VP shunt patients presenting with abdominal or neurological symptoms and perform prompt imaging for diagnosis. Proper catheter length, careful vein selection, and precise surgical technique are key to preventing VA shunt migration. Awareness of rare complications is crucial for optimal management.