Migration of peritoneal tubes was observed in two cases of ventriculoperitoneal (VP) shunting. The first patient had undergone revision of VP shunting for hydrocephalus at the age of 7 months. He had been well until the age of 16 months, when umbilical erosion was noted. Physical examination revealed that the distal tip of the peritoneal tube (non-spiral wire type) was protruding through the umbilicus. However, the patient was well, and the tube was replaced. The removed tube was contaminated with Staphylococcus aureus, but administration of antibiotics prevented postoperative infection. The second patient, an 8-month-old boy, was brought in because of failure to thrive and feeding difficulty 5 months after VP shunting for hydrocephalus. Physical examination disclosed that the distal tip of the peritoneal tube (again, a non-spiral wire type) was protruding through the anus. The cerebrospinal fluid obtained by puncture of the fontanelle yielded a turbid fluid. There was no evidence of peritonitis. The distal tube was removed, and ventricular drainage, along with administration of antibiotics, was maintained for 1 month. The shunting system was then revised.
There have been 53 reported cases of migration of shunting tubes, most of which were located in the bowel. Transumbilical migration has been previously reported only once. In that case as well as ours, Pudenz peritoneal tubes without a spiral wire were used. However, several authors have noted an increased incidence of spontaneous extrusion of the Raimondi type peritoneal tube with a spiral wire. Meningitis and/or ventriculitis carried the worst prognosis. Patients with VP shunts should be regularly examined to avoid the sort of rare complication described here.