Shunt Malfunction due to Kinking of the Catheter caused by Subcutaneous Tissue Calcification in the Supraclavicular Region in a Young Man : A Case Report

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  • 鎖骨上部の皮下組織の石灰化によりカテーテルが屈曲しシャント機能不全となった若年男性の1例
  • サコツ ジョウブ ノ ヒカ ソシキ ノ セッカイカ ニ ヨリ カテーテル ガ クッキョク シ シャント キノウ フゼン ト ナッタ ジャクネン ダンセイ ノ 1レイ

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Abstract

<p>  Ventriculoperitoneal (VP) shunts are commonly used to treat hydrocephalus. Shunt malfunctions requiring revision surgery may occur due to various factors. Here, we report a rare case of shunt malfunction due to catheter kinking caused by severe calcification of the supraclavicular subcutaneous tissues.</p><p>  A 19-year-old man visited our department with complaints of headache and vomiting. A VP shunt had been placed for hydrocephalus due to intraventricular hemorrhage when he was 1-month-old. Head computed tomography (CT) revealed ventriculomegaly in comparison to CT images taken one year prior. We attempted to change the pressure setting of the shunt valve. However, this was not possible. The ventricular catheter and valve were revised, but the symptoms and CT findings did not improve. A shuntogram revealed omega-shaped kinking of the catheter in the supraclavicular region. During the reoperation, calcified tissue was identified around the catheter. The calcified tissue was removed, and the kinking was subsequently released.</p><p>  A fibrous sheath around the catheter could have led to the formation of calcified scar tissue and the subsequent catheter kinking. Pathological examination revealed inflammation in the surrounding tissue. The calcification could have been due to the elution of barium particles from the silicon component of the catheter. To our knowledge, this is the first case wherein a good outcome was achieved by simply removing the surrounding calcified soft tissue. Frequent sites of calcification must be considered when searching for the cause of shunt malfunction.</p>

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