Laparoscopic repair of transurethral extrusion of a ventriculoperitoneal shunt: A case report

IF 0.2 Q4 PEDIATRICS
Hannah Baker , Ryan Jafrani , Cristine S. Velazco , Hubert Swana
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引用次数: 0

Abstract

Introduction

Transurethral protrusion of ventriculoperitoneal shunt is a rare finding with few reported cases in the literature. As most presentations are treated with an open surgical approach, our case details successful management with laparoscopic intervention. Here we describe the presentation, diagnosis, and management of a pediatric patient with erosion and extrusion of a ventriculoperitoneal shunt through the urethra.

Case presentation

A 3-year-old girl with a history of congenital hydrocephalus treated with ventriculoperitoneal shunt presented to the Emergency Department after an incidental finding of the peritoneal end of the shunt protruding from the urethra draining cerebrospinal fluid (CSF). The patient was asymptomatic with vitals and laboratory values within normal limits. Urine and CSF cultures were negative. Preoperative x-ray showed distal midline protrusion of the shunt. Due to exposed hardware with risk of infection, a combined surgical effort between pediatric urology, neurosurgery, and general surgery was implemented. Laparoscopy was utilized to transect the shunt tubing with subsequent removal through the urethra, revealing a posterior cystotomy. The bladder defect was closed entirely with absorbable suture. The shunt hardware was removed in its entirety and an extraventricular drain (EVD) was placed. The patient subsequently underwent an endoscopic third ventriculostomy (ETV) and did not require shunt replacement. The postoperative course was uneventful with benign follow up imaging.

Conclusion

Minimally invasive surgical intervention can be utilized as a safe and effective alternative to open surgery for treatment of ventriculoperitoneal shunt migration. As cases may present asymptomatically, a high index of suspicion with detailed physical exam should be applied.
经尿道挤压脑室腹腔分流术的腹腔镜修复术:病例报告
导言:脑室腹腔分流管经尿道突出是一种罕见病,文献中鲜有报道。由于大多数病例都采用开腹手术治疗,我们的病例详细介绍了腹腔镜介入治疗的成功案例。病例介绍一名患有先天性脑积水并接受过脑室腹腔分流术治疗的 3 岁女孩因意外发现分流管的腹膜端突出于引流脑脊液(CSF)的尿道口而到急诊科就诊。患者无症状,生命体征和实验室值均在正常范围内。尿液和脑脊液培养均为阴性。术前X光片显示分流管远端中线突出。由于硬件外露,存在感染风险,小儿泌尿科、神经外科和普通外科联合实施了手术。利用腹腔镜横切分流管,随后通过尿道将其取出,露出后方的膀胱切口。用可吸收缝线完全缝合了膀胱缺损。分流管硬件被全部移除,并放置了室外引流管(EVD)。患者随后接受了内镜下第三脑室造口术(ETV),无需更换分流器。结论微创手术干预可作为开腹手术的一种安全有效的替代方法,用于治疗脑室腹腔分流管移位。由于病例可能无症状,因此应高度怀疑并进行详细的体格检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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