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Images In Medicine
2018:31:6;375-375
doi: 10.4103/0970-258X.262907
PMID: 31397378

Retrograde migration and expulsion of ventriculoperitoneal shunt from the neck

Arunmozhi Maran Elavarasi, Abhishek Singh, Vinay Goyal
 Department of Neurology, All India Institute of Medical Sciences, New Delhi, India

Corresponding Author:
Vinay Goyal
Department of Neurology, All India Institute of Medical Sciences, New Delhi
India
drvinaygoyal@gmail.com
How to cite this article:
Elavarasi AM, Singh A, Goyal V. Retrograde migration and expulsion of ventriculoperitoneal shunt from the neck. Natl Med J India 2018;31:375
Copyright: (C)2018 The National Medical Journal of India

A 38-year-old man had a ventriculoperitoneal (VP) shunt placed for hydrocephalus due to tubercular meningitis. He had complete resolution on antitubercular treatment.

One year later, he had painless swelling at the right supraclavicular area with excoriation of the skin and a clear discharge. After 2 days, the distal end of the VP shunt was completely expelled from his neck. Clear cerebrospinal fluid was dripping from the expelled end (Fig. 1). CT head showed that the proximal end of the VP shunt was in place. To the best of our knowledge such an expulsion of the distal end of the VP shunt from the neck region has not been reported before.[1]

Various mechanisms have been proposed to explain the upward migration of the shunt. Some of these are: loose or inadequate fixation of the tubing to the pericranium, lack of a reservoir, too long a catheter, faulty technique, excessive subcutaneous undermining, etc.[2] Dominguez et al. reported the complete coiling of an Orbis Sigma valve and attributed this to the retained ‘memory’ of the shunt material within its sterile package.[3]

Conflicts of interest. None declared

References
1.
Gatto LA, Mathias R, Tuma R, Abdalla R, de Aguiar PH. Rare complication of ventriculoperitoneal shunt: Catheter protrusion to subcutaneous tissue [Case report]. Surg Neurol Int 2016;7: S1142-S1146.
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Martínez-Lage JF, Guillén-Navarro E, Almagro MJ, Felipe-Murcia M, López López-Guerrero A, Galarza M, et al. Hydrocephalus and Chiari type 1 malformation in macrocephaly-cutis marmorata telangiectatica congenita: A case-based update. Childs Nerv Syst 2010;26:13-18.
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Dominguez CJ, Tyagi A, Hall G, Timothy J, Chumas PD. Sub-galeal coiling of the proximal and distal components of a ventriculo-peritoneal shunt. An unusual complication and proposed mechanism. Childs Nerv Syst 2000;16:493-5.
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