gms | German Medical Science

Introduction: Ventriculo-peritoneal shunt implantation represents the standard procedure in the treatment of hydrocephalus and is associated with minimal morbidity. We report an unusual case of abdominal catheter dislocation.

Results: A 71 year old woman had undergone VP shunting for non-resorptive hydrocephalus after SAH due to a basilar tip aneurysm. She routinely received cCT and X-Ray of the chest and abdomen for follow up 3 months after implantation which revealed normal (intraabdominal) catheter location. 7 month after surgery she was treated conservatively for mild abdominal pain. One month later she noticed a skin cyst in her right gluteal region, which was incised by a dermatologist. Thereafter she complained about headache and nausea while draining approximately 250ml clear secret (CSF) per day by the extruded tube. Abdominal CT and 3D reconstruction demonstrates the tube going from intra- to extraperitoneal space and perforating the skin. The patient fortunately did not develop meningitis despite catheter colonisation with enterobacter cloacae. The abdominal catheter was replaced immediately.

Conclusion: Although the incidence of delayed abdominal dislocation like bowel perforation is reported to be as low as 0.1% , it represents a severe complication that requires immediate treatment. We describe the first case of transperitoneal migration and subsequent spontaneous gluteal extrusion of a peritoneal catheter.