Scientific Letters to the Editor
Extrusion of Ventriculo-peritoneal Shunt Catheter Sir, Various complications of the ventriculo-peritoneal shunt (VPS) catheter due to migration of ventricular and peritoneal ends are reported in literature.1-5 Three patients (two female and one male) aged 2, 3 and 36 mo were admitted in our institute as a follow-up case of congenital hydrocephalus with VP shunt in situ during last two yr. They had history of protrusion of shunt catheter for one day through the vagina, (Fig. 1) umbilicus; (Fig. 2) and rectum (Fig. 3) respectively. The time interval between shunt insertion and extrusion were 1.5, 3 and 35 mo. They had no any other associated complaints except the protrusion of shunt
Fig. 1. Extrusion of shunt catheter through vagina.
Basant Kumar, Shyam B Sharma and Deepak K Singh1 Department of Pediatric Surgery, Sir Padampat Mother & Child Health Institute, ( Jay Kay Lon Hospital) and 1Department of Neurosurgery, S.M.S Medical College, Jaipur-30, Rajasthan, India. Email –
[email protected],
[email protected] [DOI-10.1007/s12098-009-0309-5]
Fig. 2. Extrusion of shunt catheter through umbilicus.
catheter. There were no signs of peritonitis, septicemia, meningitis or neurological deficit. In all patients, the catheter tip was draining CSF well. All were initially managed by removing whole shunt catheter under antibiotic cover. CSF alongwith shunt reservoir was sent for culture. Intravenous antibiotics were continued for 7 days during which negative CSF cultures were ensured in all patients. After a wk, opposite side (left sided) VP shunt insertion was done in all. Postoperative period was uneventful in all the cases. Various reasons are mentioned in literature for extrusion of the shunt including poor nutrition, poor host immunity (may be due to radiation therapy or replacement steroid therapy), poor surgical technique, bioreactivity of shunt components, focal wound dehiscence, infections, ischemic or radiotherapy induced necrosis of dermis or breakdown of scar.2,5 We 336
could not find the reason behind it. We also could not find the reason; why in the two patients, shunt protrusion occurred early (
