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Subgaleal coiling of the proximal and distal components of a ventriculoperitoneal shunt

International Journal of Emergency Medicine volume 5, Article number: 15 (2012) Cite this article

Abstract

Migration is a rare complication of venticuloperitoneal shunts and is thought to be associated with the "memory" of the plastic tubing and the windlass effect of neck flexion and extension. The purpose of this case report is to detail a very rare case of complete distal to proximal shunt migration.

Case Report

An 11-month-old female with a history of multiloculated, complex intracranial cysts with shunt-dependent hydrocephalus and seizure disorder presented to the emergency department with a 2-day history of lethargy, sleepiness, nausea and vomiting. The patient was 3 days status post insertion of a left ventriculoperitoneal shunt insertion. Vital signs were stable, and physical exam revealed a large subgaleal mass at the left occipital area. (Figures 1 and 2) Skull films (Figures 3 and 4) and head CT (Figures 5 and 6) revealed that the shunt catheter was located completely outside the cranium and contained within it a 3.4 × 5.1 × 4.0-cm subgaleal fluid-filled pocket. The child was taken back to the OR, and a new shunt catheter was placed without complication. The child has since been doing well.

Figure 1
figure 1

Side Photograph Showing Coiled Shunt.

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Figure 2
figure 2

Top Photograph Showing Coiled Shunt.

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Figure 3
figure 3

AP Skull Showing Coiled Shunt.

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Figure 4
figure 4

Lateral Skull Showing Coiled Shunt.

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Figure 5
figure 5

Cross Section CT Showing Coiled Shunt.

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Figure 6
figure 6

Cross Section CT Showing Coiled Shunt and Hydrocephalus.

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Significant proximal shunt migration is an extremely rare complication that has only been reported in the literature on six occasions [1–5], with the full migration of the distal and proximal aspects of the shunt catheter into a subgaleal pocket reported only twice [2, 4]. The proposed mechanism for the migration of the catheter involves the "windlass" effect combined with the retained "memory" of the shunt tubing [2]. The flexion and extension of the child's neck in the days following the surgery combined with the "memory" of the plastic tubing were the likely culprits causing the shunt migration.

References

  1. Cheng JY, Lo WC, Liang HH, Kun IH: Migration of ventriculoperitoneal shunt into the stomach, presenting with gastric bleeding. Acta Neurochir (Wien) 2007,149(12):1269–70. 10.1007/s00701-007-1413-9

    Article  CAS  Google Scholar 

  2. Dominguez CJ, Tvagi A, Hall G, Timothy J, Chumas PD: Sub-galeal coiling of the proximal and distal components of a ventriculo-peritoneal shunt. An unusual complication and proposed mechanism. Childs Nerv Syst 2000,16(8):493–5. 10.1007/PL00007294

    Article  CAS  PubMed  Google Scholar 

  3. Fewel ME, Garton HJ: Migration of distal ventriculoperitoneal shunt catheter into the heart. Case report and review of the literature. J Neurosurg 2004,100(2 Suppl Pediatrics):206–11.

    PubMed  Google Scholar 

  4. Heim RC, Kaufman BA, Park TS: Complete migration of peritoneal shunt tubing to scalp. Childs Nerv Syst 1994,10(6):399–400. 10.1007/BF00335131

    Article  CAS  PubMed  Google Scholar 

  5. Kim KJ, Wang KC, Cho BK: Proximal migration and cutaneous coiling of a peritoneal catheter: report of two cases. Childs Nerv Syst 1995,11(7):428–31. 10.1007/BF00717412

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. SUNY Upstate Medical University, Syracuse, NY, USA

    Brian T Kloss & LaLainia Secreti

  2. University of Rochester Medical Center, Rochester, NY, USA

    David M Hart

Authors
  1. Brian T Kloss
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  2. David M Hart
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  3. LaLainia Secreti
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Correspondence to Brian T Kloss.

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Competing interests

The authors declare that they have no competing interests.

Authors' contributions

BK oversaw and edited the case report and the organization of the images as published. DH researched the current literature and wrote the body of the paper. LS oversaw patient care in the ED and obtained verbal and written consent for publication. All authors read and approved the final manuscript.

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Open Access This article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kloss, B.T., Hart, D.M. & Secreti, L. Subgaleal coiling of the proximal and distal components of a ventriculoperitoneal shunt. Int J Emerg Med 5, 15 (2012). https://doi.org/10.1186/1865-1380-5-15

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Keywords

International Journal of Emergency Medicine

ISSN: 1865-1380

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