Extrinsic Compression of the Gastric Wall by a Ventriculoperitoneal Shunt Catheter: Case Report and Literature Review^[*]

Abstract

Introduction Ventriculoperitoneal (VP) shunt is commonly used in the treatment of hydrocephalus and may present complications in up to 30% of patients. The present report addresses an uncommon complication in the abdominal cavity, in which the catheter caused extrinsic compression of the gastric wall.

Case report A 30-year-old man presented a decreased level of consciousness, associated with severe headache and vomiting. He had a history of congenital neurotoxoplasmosis and VP shunt insertion at 7 years of age. Imaging exams demonstrated the formation of an encapsulated retrogastric pseudocyst and extrinsic compression of the gastric wall by a VP shunt catheter. Through videolaparoscopy, decompression of the gastric wall and removal of the pseudocyst were performed, with the reestablishment of the drainage of cerebrospinal fluid. An analysis of the distal fragment of the removed catheter revealed obstruction by fibrotic material. The patient was discharged with a reestablished baseline after four days of hospitalization.

Comments The literature shows that ∼ 47% of the complications presented by patients are related to the distal end of the catheter, and 8.2% of these come from migration to the abdominal cavity. However, there is an extreme paucity of studies that demonstrate extrinsic compression of the gastric wall by a VP shunt catheter. Therefore, we suggest that further studies on complications involving the VP shunt be performed to improve diagnostic and therapeutic results, in addition to complementing the literature on this complication.

Resumo

Introdução A derivação ventriculoperitoneal (DVP) é comumente empregada no tratamento da hidrocefalia, e pode apresentar complicações em até 30% dos pacientes. Este relato aborda uma complicação incomum na cavidade abdominal, em que o cateter promoveu compressão extrínseca da parede gástrica.

Relato de caso Um homem de 30 anos apresentou rebaixamento do nível de consciência associado a cefaleia de forte intensidade e vômitos. O paciente tinha histórico de neurotoxoplasmose congênita e inserção de DVP aos 7 anos. Os exames de imagem demonstraram formação de pseudocisto encapsulado retrogástrico e compressão extrínseca de parede gástrica por cateter de DVP. Por meio de videolaparoscopia, foram realizadas a descompressão da parede gástrica e a remoção do pseudocisto, com o restabelecimento da drenagem de líquido cefalorraquidiano. Uma análise do fragmento distal do cateter removido revelou obstrução por material fibrótico. O paciente recebeu alta com quadro basal reestabelecido após quatro dias de internação.

Comentários A literatura mostra que ∼ 47% das complicações apresentadas pelos pacientes relacionam-se com a extremidade distal do cateter, sendo que 8,2% destas são oriundas de migração para a cavidade abdominal. Entretanto, há extrema escassez de estudos que demonstrem a compressão extrínseca da parede gástrica por cateter de DVP. Portanto, sugerimos que novos estudos envolvendo complicações de DVP sejam realizados, a fim de melhorar os resultados diagnósticos e terapêuticos, além de complementar a literatura acerca dessa complicação.

Keywords

hydrocephalus - ventriculoperitoneal shunt - complications - extrinsic compression - gastric wall

Palavras-chave

hidrocefalia - derivação ventriculoperitoneal - complicações - compressão extrínseca - parede gástrica

Ethics Statement

The present study complied with all institutional guidelines for research in human beings. Informed consent was obtained from the person responsible for the patient.

Funding Sources

No targeted funding has been reported.

^* Study conducted at Complexo Hospitalar do Trabalhador, Curitiba, Paraná, Brazil.

Publication History

Received: 18 August 2021

Accepted: 20 December 2021

Article published online:
23 September 2022

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