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Uncommon complications of ventriculoperitoneal shunt surgery: review of four cases and literature review
Egyptian Journal of Neurosurgery Pub Date : 2020-01-09 , DOI: 10.1186/s41984-019-0071-6
Aliyu Muhammad Koko , Nasiru Jinjiri Ismail , Ali Lasseini , Sahabi M. Saddiku

Ventriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting. The first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and also cerebrospinal fluid was under high pressure that warranted re-insertion of another medium pressure shunt. She remained stable at last follow-up 3 months post-surgery. We managed two cases of shunt extrusion via the anus (a 1-year-old female infant and 9-year-old boy). None of the patients presented with evidence of peritonitis or shunt tract infection. The extruded shunts were removed under aseptic technique, and both patients had ventriculoperitoneal shunt re-inserted because of progression of hydrocephalus. They remained stable at last follow-up visits 6 months after surgery. The fourth case was a 9-month-old infant that presented with shunt extrusion via the abdominal wound site 3 weeks after ventriculoperitoneal shunt procedure. The child developed an abscess at the abdominal wound that ruptures spontaneously with extrusion of distal catheter, had no features of peritonitis and had shunt removed and re-inserted after 3 months. The child has remained stable. Although ventriculoperitoneal shunt calcification and extrusion are rare, they do occur. None of our patients had peritonitis. Shunt removal and subsequent reinsertion in the presence of raised intracranial pressure from hydrocephalus confirms an excellent outcome.

中文翻译:

脑室腹腔分流术的罕见并发症:四例复习并文献复习

室腹膜分流术是全球最受欢迎的脑脊液分流手术之一。并发症很常见,但文献中很少报道罕见的并发症,因此无法获得处理异常并发症的标准化指南。我们报告了在我们中心进行的一系列罕见并发症的处理,以分享我们的经验,并为处理这些复杂的心室腹膜分流并发症提供了文献资料。第一例是一个10岁的女孩,她出现头痛,清晨呕吐和颈部分流道发痒。3个月大时,她在我们的工厂进行了脑室-腹膜分流以及脑膨出的切除和修复。身体检查时,她的格拉斯哥昏迷评分为15,有意识。分流阀已硬化。在术中发现钙化的分流管和瓣膜后,她将分流器移除,并且脑脊液处于高压状态,因此有必要重新插入另一个中压分流器。手术后三个月,她在最后一次随访中保持稳定。我们通过肛门处理了两例分流挤压术(1岁女婴和9岁男孩)。没有患者出现腹膜炎或​​分流道感染的证据。在无菌技术下取出挤压的分流管,两名患者因脑积水的进展而重新插入了脑室-腹膜分流管。他们在术后六个月的最后一次随访中保持稳定。第四例是一个9个月大的婴儿,在室腹膜分流手术3周后经腹部伤口部位分流挤压。这名儿童的腹部伤口出现脓肿,并因远端导管的挤压而自发破裂,没有腹膜炎的特征,并在3个月后将分流管切除并重新插入。孩子保持稳定。尽管室腹膜分流钙化和挤压很少见,但确实会发生。我们的患者均无腹膜炎。在脑积水引起的颅内压升高的情况下,分流器切除和随后的重新插入证实了极好的结果。没有腹膜炎的特征,三个月后取下分流器并重新插入。孩子保持稳定。尽管室腹膜分流钙化和挤压很少见,但确实会发生。我们的患者均无腹膜炎。在脑积水引起的颅内压升高的情况下,分流器切除和随后的重新插入证实了极好的结果。没有腹膜炎的特征,三个月后取下分流器并重新插入。孩子保持稳定。尽管室腹膜分流钙化和挤压很少见,但确实会发生。我们的患者均无腹膜炎。在脑积水引起的颅内压升高的情况下,分流器切除和随后的重新插入证实了极好的结果。
更新日期:2020-01-09
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