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Umbilical hernia causing ventriculoperitoneal shunt dysfunction: illustrative cases.

Lacey M Carter1, Alejandro Ruiz-Elizalde2, Naina L Gross3

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Journal of Neurosurgery. Case Lessons
|September 5, 2022
PubMed
Summary

Umbilical hernia repair resolved ventriculoperitoneal (VP) shunt dysfunction in two infants. This suggests hernias can cause shunt issues, potentially through catheter obstruction or inflammation, without direct catheter entrapment.

Keywords:
CSF = cerebrospinal fluidVP = ventriculoperitoneal shuntcase reporthydrocephalusumbilical herniaventriculoperitoneal shunt

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Area of Science:

  • Pediatric Surgery
  • Neurosurgery
  • Medical Device Complications

Background:

  • Coexistence of ventriculoperitoneal (VP) shunts and umbilical hernias presents unique clinical challenges.
  • Common complications include cerebrospinal fluid (CSF) fistulas and catheter entrapment within the hernia.
  • This study investigates an atypical presentation of VP shunt dysfunction associated with umbilical hernias.

Observation:

  • Two infant patients with shunted hydrocephalus and umbilical hernias presented with distal VP shunt malfunctions.
  • These malfunctions were not attributed to infection.
  • Shunt function improved following surgical repair of the umbilical hernias.

Findings:

  • VP shunt dysfunction resolved in both cases after umbilical hernia repair.
  • Neither patient has required shunt revision since the hernia repair.
  • This suggests a potential causal link between umbilical hernias and VP shunt malfunction.

Implications:

  • Challenges the notion that VP shunt dysfunction in the presence of umbilical hernias solely results from direct catheter entrapment or CSF fistulas.
  • Proposes intermittent catheter obstruction or hernia-related inflammation as potential mechanisms for shunt dysfunction.
  • Highlights the importance of considering umbilical hernia repair in managing VP shunt dysfunction in affected pediatric patients.