INVASION OF A PERITONEAL CATHETER INTO THE INFERIOR VENA CAVA: REPORT OF A UNIQUE CASE F. Haralampopoulos,
M.D., H. Iliadis, S. Karniadakis, and D. Koutentakis
Neurosurgery Department, Venizelion Hospital, Crete, Greece
Haralampopoulos F, lliadis H, Karniadakis S, Koutentakis D. Invasion of the peritoneal catheter into the inferior vena cava: report of a unique case. Surg Neural 1996;46:21-2.
A case is reported in which the peritoneal catheter of a ventriculoperitoneal shunt was found to have eroded into the inferior vena cava. It was working well, draining CSF, even though oriented against the flow of blood.
he ventriculoperitoneal (VP) shunt is the most popular shunt currently in use. In comparison to the ventriculoatrial (VA) shunt, the VP shunt has a lower rate of significant complications. Some of the complications of VP shunts have been unusual. For example, there has been migration of the peritoneal catheter into the stomach, gallbladder, urinary bladder, vagina, liver, bowel, colon, and diaphragm and even exit of the catheter through the abdominal wall [5,-&lo-131. We are reporting a case in which the peritoneal catheter of a VP shunt eroded into the inferior vena cava. This is the first case report of such a complication.
CASEREPORT A 22-year-old Swedish female was visiting Crete while on vacation during the summer of 1990. She was involved in a motor vehicle accident and was admitted to Venizelion Hospital with a severe head injury. A CT scan of the head showed significant brain injury and the existence of a shunt. An abdominal X-ray demonstrated that a Raimondi peritoneal catheter was in the right lower quadrant. The patient died several hours after her severe head injury. On autopsy, it was found that the Raimondi peritoneal catheter was retroperitoneal. After opening the retroperitoneal space the catheter was found to have eroded 7 cm. into the inferior vena Address reprint requests to: F. Haralampopoulos, MD, Chairman of Neurosurgery Department, Venizelion Hospital, 47 Damaskinou Street, 71305 Heraklion, Crete, Greece. Received February 27, 1995; accepted December 6. 1995 0 1996 by F. Haralampopoulos
cava. Three centimeters of the catheter was in the right common iliac vein. The catheter was still draining cerebrospinal fluid (Figure 1).
DISCUSSION Both atria1 and peritoneal shunts have complications unique to their respective type of shunting. Some of the complications unique to ventriculoatrial shunts are bacterial endocarditis, cardiac arrhythmias and tamponade, endocardial thrombi, and pulmonary hypertension secondary to embolism. Likewise, some of the complications unique to placement of a peritoneal catheter are ascites, bowel obstruction, peritonitis, pseudocysts, hydrocele, and the migration of catheters into various sites, such as bowel, stomach, urinary bladder, gallbladder, vagina, and through the diaphragm and abdominal wall [ 1,2,4,5-131. In addition, there have been cases of retrograde migration of the peritoneal catheter into the lateral ventricle . The type of complication presented here, namely migration of the peritoneal catheter into the inferior vena cava, has not been previously reported. The reason for perforation of the peritoneal catheter into various structures is unknown. It may be that stiffness of the Raimondi catheter promotes tissue perforation or that fracture of the wire in the catheter causes irritation leading to penetration. Certainly this is not the only answer, since nonwire wound catheters have also been found to migrate into various body parts . It should be noted that migration of a catheter into a hollow viscus can be lethal and, therefore, penetration of a viscus cannot be taken lightly [ 1,131. Complications of catheter migration are usually easily diagnosed by simple X-ray of the head, chest, and abdomen, since peritoneal shunt catheters are now radioopaque. 009s3019/96 PI1 SOO90-3019(96)00052-3
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6. 7. 8. 9. Photograph of catheter in vena cava. R: Catheter qUreter.Raimondi; VC: Vena Cava; P: Psoas m; 0: Ovary; U:
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ISTEN NOT TO THE TABLEBEARER, FOR HE MAY TELL THEE NOTHING OUT OF GOOD WILL, BUT AS HE DISCOVERETH OF THE SECRETS OF OTHERS, SO HE WILL OF THINE IN TURN. SOCRATES