Rationale: Ventriculoperitoneal shunt (VPS) surgery, a common neurosurgical procedure for hydrocephalus, carries risks of complications such as shunt obstruction and infection. Migration of the shunt into the mediastinum, however, is an uncommon complication, particularly in adults. Patient concerns: A 56-year-old male patient was admitted to our hospital with a complaint of “progressive decline in mobility over 3 months, significantly impairing daily activities.” He had previously undergone bilateral VPS surgery and was admitted with a suspected shunt obstruction. Diagnoses: Chest radiography showed that the left ventricular-ventral end shunt had migrated through the supra-aortic arch and mediastinum to the right atrial region. Chest computed tomography showed that the left shunt image entered the mediastinum, and multiple strip high-density images could be seen in the mediastinal cavity. Interventions: External drainage of a right VPS catheter was performed. Intraoperative findings revealed that the left-sided peritoneal catheter migrated into the thoracic cavity. Nineteen days later, the bilateral VPS catheters were revised, and the left shunt catheter was extracted from the thoracic cavity and repositioned into the abdominal cavity; the right shunt catheter was reinserted into the peritoneal cavity. Outcomes: Both shunt catheters were successfully repositioned into the peritoneal cavity. No thoracic or abdominal complications were documented during the perioperative period. During the 6-month follow-up period, the patient maintained neurological improvement without complication recurrence. Lessons: After VPS surgery, shunt migration should be considered a potential cause of obstruction. Once identified, the migrated shunt tube should be promptly readjusted to restore its proper function.
Feng et al. (Fri,) studied this question.
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