Intrathoracic migration of ventriculo-peritoneal shunt via Morgagni hernia
- PDF / 847,049 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 55 Downloads / 137 Views
CASE REPORT
Intrathoracic migration of ventriculo-peritoneal shunt via Morgagni hernia Paige A. Lundy 1,2
&
Michael D. Partington 1,3,4 & Chad A. Tuchek 1 & David M. Garcia 1,3,4
Received: 6 June 2020 / Accepted: 12 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract We present the case of a 5-month-old patient presenting with pleural migration of ventriculo-peritoneal shunt catheter who returned 2 months later with respiratory distress. Ultimately, the diagnosis of a Morgagni hernia was made. This diagnosis, though rare, should be entertained in certain clinical settings. Keywords Ventriculo-peritoneal shunt migration . Morgagni hernia . Shunt malfunction . Congenital hernia
Abbreviations VPS Ventriculo-peritoneal shunt CDH Congenital diaphragmatic hernia
Introduction Intrathoracic migration of ventriculo-peritoneal shunt (VPS) catheters is a rare but previously described phenomenon [2, 5–8, 10–12, 16, 17, 19, 21, 22]. Resulting pleural effusions can be life-threatening especially in pediatric patients. VP shunts can migrate to the thoracic cavity via the supradiaphragmatic route resulting from accidental passage into the pleural cavity during shunt tunneling or from local inflammation resulting in erosion of the diaphragm and ultimate shunt migration [2, 12, 23]. They may also migrate trans-
This material was previously presented at the American Society of Pediatric Neurosurgeons 42nd Annual Meeting, Koloa, Hawaii Jan 27Feb 1, 2019 * Paige A. Lundy [email protected] 1
Department of Neurological Surgery, University of Kansas, Kansas City, KS, USA
2
The University of Kansas Health System, 3901 Rainbow Blvd Mail Stop 3021, Kansas City, KS 66160, USA
3
Children’s Mercy Hospital, Kansas City, MO, USA
4
University of Missouri at Kansas City, Kansas City, MO, USA
diaphragmatically via the foramen of Bochdalek or Morgagni [10, 21, 23]. These congenital diaphragmatic hiatuses are located both anteriorly at the costal-sternal junction (foramen of Morgagni) and posteriorly at the costal-spinal junction (foramen of Bochdalek) [10]. We present the second confirmed pleural migration of a VP shunt via a Morgagni hernia.
Case presentation A former 23-week gestational age infant developed posthemorrhagic hydrocephalus and was initially managed with a ventriculo-subgaleal shunt. At 3 months of age, this was converted to a left ventriculoperitoneal shunt (VPS) in an unremarkable surgery. Postoperative imaging confirmed intra-abdominal placement of the distal VPS (Fig. 1). At 5 months of age, the child returned with agitation and emesis for 2 days. Shunt series revealed that the distal catheter was in the left pleural cavity, with significant pleural fluid (Fig. 1). A distal shunt revision was done by the initial surgeon. The entire distal catheter was removed, and a new one was tunneled and replaced into the peritoneal cavity. The patient did not experience increased oxygen requirements at that time and did not require drainage of the pleural fluid collection; thus, further pulmonary wo
Data Loading...
