Management of trans-anal extrusion of distal ventriculoperitoneal shunt catheter in children
Abstract
Background: The objectives of this study were to review the demographics, clinical characteristics, surgical procedures executed, and the outcome of children operated upon for trans-anal extrusion of the distal VPS (ventriculoperitoneal shunt) catheter.
Methods: Case records of children under 12-years, operated upon for the trans-anal extrusion of the distal VPS catheter, were reviewed in detail.
Results: This study comprised of, n=25 children and included, n=14 boys and, n=11 girls. The interval from the primary VPS insertion/VPS revision to the diagnosis of trans-anal extrusion of the distal VPS catheter ranged from 2 to 49-months, with a mean of 10.04 (11.58 SD/ months. Clinically, all children presented with trans-anal extrusion of the distal VPS catheter. None of them had clinical features of peritonitis, intestinal obstruction, or meningitis. Operative procedures performed in the following order of frequency; (a) removal and immediate revision of the peritoneal/distal VPS catheter n=15 (60%), (b) removal of entire VPS catheter and delayed re-VPS insertion n=4 (16%), (c) removal of peritoneal/distal VPS catheter, external ventricular drainage (EVD) followed by delayed re-VPS insertion n=3 (12%), (d) removal of entire VPS catheter and immediate re-VPS insertion n=1 (4%) and (e) removal of entire VPS catheter alone n=2 (8%).
Conclusions: Trans-anal extrusion of the distal VPS catheter is well-known, but rare complication of the VPS insertion done in children. In sixty percent of children, removal and immediate revision of the peritoneal/distal VPS catheters were done safely by mini-laparotomy. During the management, formal abdominal explorations were neither executed nor required in any case.
Keywords
Full Text:
PDFReferences
Smith JL. Management of neural tube defects, hydrocephalus, refractory epilepsy, and central nervous system infections. Coran AG, Adzick NS, Krummel TM, Laberge JM, Shamberger RC, et al (eds). In: Pediatric Surgery 7th edn. Elsevier Inc. 2012;1673-97.
Notarianni C, Vannemreddy P, Caldito G, Bollam P, Wylen E, Willis B et al. Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiology and programmable shunts on revisions. J Neurosurg Pediatr. 2009;4:547-52.
Wang JY, Jackson EM, Jallo GI, Ahn ES. Shunt revision requirements after posthemorrhagic hydrocephalus of prematurity: insight into the time course of shunt dependency. Childs Nerv Syst. 2015;31:2123-30.
Kankane VK, Gupta TK, Jaiswal G. Outcome of ventriculoperitoneal shunt surgery, without prior placement of external ventricular drain in Grades III and IV patients of tubercular meningitis with hydrocephalus: A single institution's experience in the pediatric population and review of literature. J Pediatr Neurosci. 2016;11:35-41.
Naftel RP, Argo JL, Shannon CN, Taylor TH, Tubbs RS, Clements RH et al. Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. J Neurosurg. 2011;115:151-8.
Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr. 2013;11:15-9.
Paff M, Alexandeu-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: A review. Interdisciplinary Neurosurg. 2018;13:66-70.
Reddy GK, Bollam P, Caldito G. Long-term outcomes of ventriculoperitoneal shunt surgery in patients with hydrocephalus. World Neurosurg. 2014;81:404-10.
Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. Ventriculoperitoneal shunt complications needing shunt revision in children: A review of 5 years of experience with 48 revisions. Afr J Paediatr Surg. 2012;9:32-9.
Sathyanarayana S, Wylen EL, Baskaya MK, Nanda A. Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases. Surg Neurol. 2000;54:388-96.
Thiong'o GM, Luzzio C, Albright AL. Ventriculoperitoneal shunt perforations of the gastrointestinal tract. J Neurosurg Pediatr. 2015;16:36-41.
Ezzat AAM, Soliman MAR, Hasanain AA, Thabit MA, Elshitany H, Kandel H et al. Migration of the distal catheter of ventriculoperitoneal shunts in pediatric age group: Case series. World Neurosurg. 2018;119:e131-7.
Chiang LL, Kuo MF, Fan BJ, Hsu WM. Transanal repair of colonic perforation due to ventriculoperitoneal shunt- Case report and review of the literature. J Formos Med Assoc. 2010;109:472-5.
Chhabra DK. The saga of the 'Chhabra' shunt. Neurol India. 2019;67:635-8.
Ghritlaharey RK. Review of the management of peroral extrusion of ventriculoperitoneal shunt catheter. J Clin Diagn Res. 2016;10:PE01-6.
Feeney V, Ansar N, Donaldson-Hugh B, Alalade AF. Transoral protrusion of a ventriculoperitoneal catheter caused by jejunal perforation in an adult: rare case report and review of the literature. World Neurosurg. 2020;137:200-5.
Ghritlaharey RK. Systematic review of migration of distal ventriculoperitoneal shunt catheter into the urinary bladder with or without per-urethral extrusion. Med J DY Patil Vidyapeeth. 2022.
Chugh A, Gotecha S, Amle G, Patil A, Punia P, Kotecha M. Abnormal migration and extrusion of abdominal end of ventriculoperitoneal shunt: An experience of eight cases. J Pediatr Neurosci. 2018;13:317-21.
Ghritlaharey RK. Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021. Int J Res Med Sci. 2021;9:3416-23.
Vinchon M, Baroncini M, Laurent T, Patrick D. Bowel perforation caused by peritoneal shunt catheters: diagnosis and treatment. Neurosurgery. 2006;58(1):ONS76-82.
Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, Nanda M et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int. 2007;23:575-80.
Hai A, Rab AZ, Ghani I, Huda MF, Quadir AQ. Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature. J Indian Assoc Pediatr Surg. 2011;16:31-3.
Hasan A, Sharma S, Chopra S, Purohit DK. Anal extrusion of ventriculoperitoneal shunt: A report of two cases and review of literature. J Pediatr Neurosci. 2018;13:8-12.
Teegala R, Kota LP. Unusual complications of ventriculo peritoneal shunt surgery. J Neurosci Rural Pract. 2012;3:361-4.
Koko AM, Ismail NJ, Lasseini A, Saddiku SM. Uncommon complications of ventriculoperitoneal shunt surgery: review of four cases and literature review. Egypt J Neurosurg. 2020;35:2.
Handa R, Kale R, Harjai MM. Unusual complication of ventriculoperitoneal shunt: Anal extrusion. Med J Armed Forces India. 2007;63:82-4.
Liu Y, Li C, Tian Y. Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature. Chin Neurosurg J. 2017;3: