Thaker Nikhil G, Mammis Antonios, Yanni Daniel S, Singh Rahul, Carmel Peter W
New Jersey Medical School, New Jersey, USA.
J Surg Case Rep. 2010 Sep 1;2010(7):9. doi: 10.1093/jscr/2010.7.9.
Distal ventriculo-peritoneal shunt migration and extra-peritoneal CSF pseudocyst formation are unusual complications of shunt placement. We present a 65-year-old-female who received a subgaleal-peritoneal shunt to decompress a post-surgical subgaleal fluid collection. Eight weeks later, shunt series showed tight coiling of the distal catheter, and operative exploration found the distal shunt tip to have migrated superficial to the rectus sheath, where it had become encapsulated in a pre-peritoneal CSF pseudocyst. Migration of the distal catheter into the abdominal wall was likely due to local inflammation of the inner surface of the abdomen, with pressure from intestinal peristaltic movements and intra-abdominal pressure, and continued inflammation at the distal catheter tip may have caused formation of a pre-peritoneal CSF pseudocystic dilatation. To date, this is the first reported case of distal shunt migration into the abdominal wall with subsequent formation of an extra-peritoneal pseudocyst and represents a rare event in the surgical management of peritoneal shunts.
远端脑室 - 腹腔分流管移位及腹膜外脑脊液假性囊肿形成是分流管置入术罕见的并发症。我们报告一例65岁女性，她接受了帽状腱膜下 - 腹腔分流术以减压术后帽状腱膜下积液。八周后，分流管造影显示远端导管紧密盘绕，手术探查发现远端分流管尖端已移位至腹直肌鞘表面，在此处它被包裹在腹膜前脑脊液假性囊肿中。远端导管向腹壁移位可能是由于腹部内表面局部炎症、肠道蠕动和腹腔内压力的作用，而远端导管尖端持续的炎症可能导致了腹膜前脑脊液假性囊肿扩张的形成。迄今为止，这是首例报道的远端分流管移位至腹壁并随后形成腹膜外假性囊肿的病例，在腹膜分流术的外科治疗中实属罕见。
