Ventriculoperitoneal shunt catheter migration through umbilicus, a rare complication

Dipankar Sarkar; Shruti Sarkar

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Dipankar Sarkar, Shruti Sarkar.

Department of Pediatrics, Peoples College of Medical Science & Research Center, Bhopal, MP, India.

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Dr Dipankar Sarkar, HIG-13, A-Block, Peoples Medical College Campus, Bypass Road, Bhanpur, Bhopal, MP-462010.
Email: dipankarshruti@gmail.com

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A 9 month old baby was brought to our outpatient department with the complaint of a plastic tube protruding out of abdomen through umbilicus for a few days. The baby had undergone Ventriculoperitoneal shunt surgery nearly 4 months back for congenital hydrocephalus in another hospital. He was born at term by caesarean section and was diagnosed to have congenital hydrocephalus soon after birth. The baby had recovered well from surgery, was feeding well on demand and thriving. On examination the baby looked well and the VP shunt catheter was seen protruding out of umbilicus (Figure 1). On pressing the shunt reservoir behind the ear, fluid started dribbling out of the tube protruding through the umbilicus confirming the protruding end to be the distal end of the VP shunt. Systemic examination apart from this did not reveal any other abnormality. The infant along with his parents had come from a distant village. The parents were explained in detail the occurrence of this complication and the need for correction by surgery. They declined corrective surgery and were lost to subsequent follow up.

Figure 1: Distal end of VP shunt protruding from the umbilicus

Figure 1: Distal end of VP shunt protruding from the umbilicus

Migration or protrusion of the ventriculoperitoneal shunt catheter to various sites is not very uncommon and has been reported in several case reports. Cases of shunt migration into stomach (1), bowel (2), liver (3), chest (4), jugular vein (5), anus (6), vagina (7), and scrotum (8) have been reported. In 1973 Adeloye et al reported a 9 month old baby with shunt migration through umbilicus within 2 months after surgery (9). Another case has been reported from Srinagar, India in 2000 where an 18 month old child presented with low grade fever, irritability, abdominal pain along with the distal end of VP shunt coming out through the umbilicus (10) .This particular complication can be explained on anatomical basis. Umbilicus is a centrally situated scar and it becomes an area of anatomical weakness when there is a foreign body inside the abdomen. There are five ridges in the peritoneum that line the lower part of the anterior abdominal wall, which converge in the midline at the umbilical region. Peristaltic activities can thus direct foreign bodies in the peritoneal cavity toward the umbilicus and push it to come out (9). Migration of the lower end of the shunt catheter is an infrequent problem, which occurs without any recognizable cause. The reported incidence of distal shunt migration is 10% (11). Of all the sites of distal end migration reported so far umbilicus is very rare.

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References

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