- Department of Neurosurgery, Kagoshima City Hospital, Kagoshima, Japan
- Department of Respiratory Surgery, Kagoshima City Hospital, Kagoshima, Japan
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
DOI:10.4103/2152-7806.168314Copyright: © 2015 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Kawahara T, Yanagi M, Hirano H, Arita K. Intra-bronchial migration of peritoneal catheter of lumboperitoneal shunt. Surg Neurol Int 27-Oct-2015;6:167
How to cite this URL: Kawahara T, Yanagi M, Hirano H, Arita K. Intra-bronchial migration of peritoneal catheter of lumboperitoneal shunt. Surg Neurol Int 27-Oct-2015;6:167. Available from: http://surgicalneurologyint.com/surgicalint_articles/intra%e2%80%91bronchial-migration-of-peritoneal-catheter-of-lumboperitoneal-shunt/
Background:A rare case of intra-bronchial migration of peritoneal catheter of lumboperitoneal (LP) shunt was treated under the bronchoscopic and fluoroscopic observation.
Case Description:A 71-year-old man, who underwent LP shunt installation due to idiopathic normal pressure hydrocephalus a year before, presented with history of high fever and sputum production. Roentgenography and computed tomography of the chest revealed migration of distal end of the peritoneal catheter into the left main bronchus. Migrated catheter was gently extracted through the abdominal wound incision under the bronchoscopic and fluoroscopic observation. Contrast material infused into the catheter did not spread into the pleural cavity. The patient was free of the symptoms within 2 postoperative weeks. Moreover, he underwent the ventriculo-peritoneal shunt surgery 1-month later.
Conclusion:This is the first case of the migration of peritoneal catheter of LP shunt into the main bronchus.
Keywords: Bronchial migration, contrast medium injection, lumboperitoneal shunt
Lumboperitoneal (LP) shunt is a common and less invasive method, in which brain injury is avoidable, for treating idiopathic normal pressure hydrocephalus (iNPH).[
A 71-year-old man presented with history of high fever and sputum production accompanied with inflammatory reaction (white blood cell: 23,100/μL, C-reactive protein: 3.92 mg/dL). One-year before, he had undergone an LP shunt surgery at another hospital for iNPH manifesting as gait disturbance and urinary incontinence. On admission, however, the shunt system did not work.
A chest roentgenography showed a tube, coinciding with the peritoneal catheter of LP shunt, in the left thorax. Computed tomography scan demonstrated distal end of the catheter in the left main bronchus [
We planned to remove the migrated peritoneal catheter with preparation for repair of bronchial air leak. Under the general anesthesia, the tip of the peritoneal catheter was viewed with bronchoscope [
The extracted peritoneal catheter was found angulated using a silicon sheath, which was tethered to peritoneum [
One month later, he underwent the VP shunt surgery, and peritoneal catheter was placed in the pelvic cavity using the method previously reported.[
Intra-pleural migration of peritoneal catheter of the shunt systems through the diaphragm is also reported in patients who underwent VP shunt surgery.[
Pulling out the migrated catheter through the bronchial wall and diaphragm could cause complications including pneumothorax and pneumoabdomen. Therefore, we prepared for these risks with the assistance of thoracic and general surgeons. Intraoperatively, bronchoscopic observation assured the absence of bronchial wall disruption or bleeding and infusion of contrast media into the migrated catheter showed absence of leakage of the media from the fistulous tract. The fistulous tract seemed to have collapsed immediately after the removal of the catheter.
In summary, migration of peritoneal catheter of LP shunt into the bronchus can occur rarely when the free movement of the peritoneal catheter is restricted. Removal of the catheter should be performed with sufficient precautions and preparations for the possible thoraco-abdominal complications.
Trans-diaphragmatic intra-bronchial migrations of distal end of peritoneal catheter of LP or VP shunt are rarely encountered. Removal of the migrated catheter should be performed with properly for the possible thoraco-abdominal complications.
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