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Ventriculoperitoneal shunt obstruction
From WikEM
Contents
Background
- Most common type of shunt malfunction
- Usually occurs at proximal tubing, followed by distal tubing followed by valve chamber
- Proximal obstructions usually occurs within first years of insertion
- Distal obstruction usually occurs only with shunts in place for >2yr
- 60% of children suffer malfunction within lifetime
Causes
- Proximal obstruction
- Tissue debris
- Choroid plexus
- Clot
- Infection
- Catheter-tip migration
- Localized immune response to the tubing
- Distal obstruction
- Kinking or disconnection of the tube
- Pseudocyst formation
- Infection
Clinical Features
- Infants with bulging fontanels and suture diastasis
- Irritability
- Change in level of consciousness
- nausea and vomiting, poor feeding
- Seizure
- Cushing's triad
Differential Diagnosis
Ventriculoperitoneal shunt problems
- Ventriculoperitoneal shunt obstruction
- Ventriculoperitoneal shunt overdrainage (Slit Ventricle Syndrome)
- Ventriculoperitoneal shunt infection
- Ventriculoperitoneal shunt mechanical failure
Evaluation
- Shunt series
- CT scan with out contrast
- Ventricular tap
- MRI, unless patient has programmable shunt (Can be recalibrated by Neurosurgery if needed)
- Pumping shunt (institution dependent) - may pull choroid plexus into shunt or cause intraparenchymal bleed
Management
- Rapid deterioration and NSGY capability distant, may require shunt tap until pressure < 15 mmHg
- If pressure not relieved by shunt tap, obstruction likely proximal
Disposition
See Also
External Links
References
Authors
Ross Donaldson, Kevin Lu, Justin Arndt, Neil Young, Daniel Ostermayer
