Fewel Matthew E, Garton Hugh J L
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-0338, USA.
J Neurosurg. 2004 Feb;100(2 Suppl Pediatrics):206-11. doi: 10.3171/ped.2004.100.2.0206.
Migration of distal ventriculoperitoneal shunt tubing is known to occur in a wide of variety of locations. The authors report an unusual complication involving a previously confirmed intraperitoneal shunt catheter that migrated into the heart and pulmonary vasculature. Radiographic evidence suggested that this occurred secondary to cannulation of a segment of the external jugular vein with a shunt trochar during tunneling of the distal catheter. This is the sixth reported case of a peritoneal shunt tube migrating proximally into the heart. The authors review the literature regarding migration of distal tubing into the heart and pulmonary artery. Based on imaging studies obtained in the present case, the authors posit that the mechanism for this unusual type of shunt migration is inadvertent penetration of either the internal or external jugular vein during the initial tunneling procedure. Negative intrathoracic pressure and slow venous flow then draws the catheter out of the peritoneum and into the vasculature. The distal catheter then migrates into the right side of the heart and pulmonary artery. Diagnosis and management of this type of complication is discussed.
已知远端脑室腹腔分流管会在多种不同位置发生移位。作者报告了一例罕见的并发症，涉及一根先前已证实位于腹腔内的分流导管移位至心脏和肺血管系统。影像学证据表明，这是在远端导管隧道化过程中，分流穿刺针误穿一段颈外静脉所致。这是第六例报道的腹腔分流管向近端移位至心脏的病例。作者回顾了有关远端分流管移位至心脏和肺动脉的文献。基于本病例获得的影像学研究结果，作者推测这种不寻常类型的分流管移位机制是在初始隧道化过程中无意穿透颈内静脉或颈外静脉。随后，胸腔内的负压和缓慢的静脉血流将导管从腹膜吸出并带入血管系统。然后，远端导管移位至心脏右侧和肺动脉。本文讨论了这类并发症的诊断和处理方法。
