Cerebrospinal fluid leakage from the umbilicus: Case report and literature review
Ilyas Dolas1, Hasan Ogunc Apaydin2, Seyho Cem Yucetas1
1Department of Neurosurgery, Adiyaman University Education and Research Hospital, Adiyaman, Turkey.
Insights
An umbilical cerebrospinal fluid fistula is a rare complication of ventriculoperitoneal shunts. Early detection of the shunt tip in the umbilical region is crucial for prompt management in infants.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Gastroenterology
Background:
- Ventriculoperitoneal (VP) shunts are used to treat hydrocephalus.
- Shunt catheters can migrate and perforate intra-abdominal organs.
- Umbilical cerebrospinal fluid (CSF) fistula is an extremely rare VP shunt complication.
Purpose of the Study:
- To report a rare case of umbilical CSF fistula after VP shunt placement.
- To highlight the importance of vigilant monitoring for shunt-related complications in infants.
Main Methods:
- Case report of an 8-month-old infant presenting with umbilical fluid leak 7 months post-VP shunt surgery.
- Clinical examination and surgical intervention to address the complication.
Main Results:
- The infant presented with a clear fluid leak from the umbilicus, indicative of a CSF fistula.
- Surgical exploration revealed the shunt's distal tip in the umbilical region.
- Post-operative follow-up was uneventful.
Conclusions:
- Chronic irrigation, material allergy, or foreign body reactions can cause sterile inflammation, leading to shunt extrusion and CSF leakage.
- Infants with shunt tips detected in the umbilical region require frequent monitoring for umbilical shunt pathologies.
Introduction:
Shunt catheters within the peritoneal cavity have migrated through and perforated almost all the intra-abdominal hollow viscera. An umbilical cerebrospinal fluid fistula following a ventriculoperitoneal shunt is an extremely rare complication.
Case Presentation:
We report a 8-month-old infant who presented with leak of clear fluid from the umbilicus, seven months after a ventriculoperitoneal shunt operation. We could not see distal tip of the shunt on examination. After the operation, the patient's follow-up was uneventful.
Discussion:
The direct effect of CSF and VP shunt, such as chronic irrigation, silicon allergy, foreign body reaction, may cause sterile inflammation on the abdominal structures and this inflammation may soften tissue and cause CFS leakage and VP shunt extrusion.
Conclusion:
If the distal tip detected on umbilical region, these patients should be examined frequently for umbilical shunt pathologies, especially infants.
