Abstract
A rare complication, migration of the peritoneal catheter of a ventriculo-peritoneal shunt, is reported. The patient was a 23-year-old female who had a ventriculo-peritoneal shunt installed at the age of 19 years, for her hydrocephalus secondary to tuberculous meningitis. The patient had 3 days' history of seizure and recurrent bouts of fever. A plain chest X-ray revealed the tip of the peritoneal catheter in the right hilar area with local pneumonitis. Metrizamide shuntgram revealed seepage of the contrast material into the right lower thoracic cavity. A computed tomography scan of the thorax confirmed the presence of the tip of the catheter in the right hilar area, and the site of entry into the thoracic cavity was identified as the anterior portion of the right diaphragm. The patient underwent shunt revision and the peritoneal catheter was repositioned into the peritoneal cavity.
Among various complications related to peritoneal catheters of ventriculo-peritoneal shunts, migration of a peritoneal catheter into the thoracic cavity by perforation through the diaphragm is extremely rare. The literature is reviewed regarding perforation of various viscera by peritoneal catheters of ventriculo-peritoneal shunts, and the possible causative mechanism of migration of a peritoneal catheter into the thoracic cavity is discussed. Although there is no consensus regarding the optimal length of a peritoneal catheter, unnecessarily long peritoneal catheters should be avoided.
