Pericardial migration of ventriculoperitoneal shunt: a case report with review of the literature.

BACKGROUND

Ventriculoperitoneal (VP) shunting is the standard surgical treatment for hydrocephalus, yet it is associated with a wide range of complications. Distal catheter migration into the pericardial cavity is exceedingly rare and poses an immediate life-threatening risk due to potential cardiac tamponade.

CASE PRESENTATION: A 1-year-old male infant, who had undergone VP shunt insertion for congenital communicating hydrocephalus at 3 months of age, presented with acute respiratory distress. Neuroimaging revealed a right-sided subdural hygroma. Chest imaging demonstrated a right pleural effusion and a large pericardial effusion, with the distal tip of the VP shunt catheter visualized within the pericardial sac. Urgent multidisciplinary intervention involving neurosurgery, pediatric surgery, and cardiothoracic surgery was undertaken. The migrated catheter was removed; the pericardial defect was repaired, and a new distal catheter was repositioned into the peritoneal cavity. Temporary ligation of the shunt was performed to manage the subdural hygroma, followed by gradual reopening after clinical and radiological resolution.

CONCLUSION

Pericardial migration of a VP shunt is a rare but potentially fatal complication. Early recognition through appropriate imaging and prompt multidisciplinary surgical management are crucial to achieving favorable outcomes and preventing mortality.