Suryadevara Raviteja, Lieber Bryan A, Garcia Erick, Sood Sandeep, Haridas Abilash, Ham Steven
Wayne State University Department of Neurosurgery, Children's Hospital of Michigan Department, Detroit, MI, USA.
Childs Nerv Syst. 2018 Apr;34(4):787-789. doi: 10.1007/s00381-017-3689-2. Epub 2018 Jan 2.
This case examines a unique, longitudinal presentation of an abandoned, migrating VP shunt which presents as multiple complications, including a weeping abscess in the patients back. We believe that the latter complication was potentially caused by the wound from the patient's previous history of spinal fusion surgery.
The patient presents with an associated type 2 Chiari malformation, hydrocephalus, and a previous history of posterior spinal fusion (T4-L5 anterior fusion and T2-L5 posterior fusion) at age 11. The patient had undergone shunt revisions in early adolescence as well. At 22, the patient is admitted into emergency care due to recurrent infections caused by a migrating VP shunt. Due to complications in corrective surgery at the time, the shunt was forced to be abandoned. This resulted in the most recent presentation of a weeping abscess at the patient's spinal fusion surgery wound; the culprit was the abandoned, migrating VP shunt..
MANAGEMENT/OUTCOME: An initial course of broad-spectrum antibiotics was started. However, the abscess continued to recur. Eventually, the catheter was surgically removed, a tailored antibiotic regiment was started, and a 6-month patient follow-up was performed. The patient is no longer symptomatic and off of antibiotics.
In abandoned VP shunts, migration into a non-sterile cavity dictates prompt removal, especially after symptoms of infection present. Additionally, careful monitoring for signs of peritonitis or other symptoms for a dedicated period of time is necessary. To the authors' best knowledge, this is the first case of an occult shunt migration through the patient's back that presented with a weeping abscess.
本病例研究了一例独特的、纵向呈现的废弃移位脑室腹腔分流管，该分流管引发了多种并发症，包括患者背部出现的渗液性脓肿。我们认为后一种并发症可能是由患者既往脊柱融合手术的伤口所致。
该患者伴有2型Chiari畸形、脑积水，11岁时曾有后路脊柱融合手术史（T4 - L5前路融合及T2 - L5后路融合）。患者在青春期早期也接受过分流管修复手术。22岁时，患者因移位的脑室腹腔分流管引发反复感染而入院接受急诊治疗。由于当时矫正手术出现并发症，分流管被迫废弃。这导致了患者脊柱融合手术伤口处最近出现渗液性脓肿；罪魁祸首是废弃且移位的脑室腹腔分流管。
治疗/结果：开始使用广谱抗生素进行初始疗程治疗。然而，脓肿持续复发。最终，通过手术取出导管，开始使用定制的抗生素方案，并对患者进行了6个月的随访。患者不再有症状，且已停用抗生素。
在废弃的脑室腹腔分流管病例中，若移位至非无菌腔隙，则需迅速取出，尤其是在出现感染症状后。此外，有必要在一段特定时间内仔细监测腹膜炎迹象或其他症状。据作者所知，这是首例隐匿性分流管经患者背部移位并出现渗液性脓肿的病例。
