Subcutaneous Migration of Distal Ventriculoperitoneal Shunt Catheter in Morbidly Obese Patients: Two Case reports

Abstract

Background: VP shunt failure due to distal catheter migration is an uncommon complication mainly associated with increased intra-abdominal pressure related to obesity. Observations: We report two cases of morbidly obese patients who presented with recurrent distal catheter migration and pseudocyst formation in the subcutaneous space less than a month following VP shunt placement for the management of hydrocephalus. Conclusion: Special attention must be given when placing a VP shunt in morbidly obese patients. There are various methods to prevent tube migration in such patients, like using a longer catheter tube, tight closure of the peritoneum while placing the catheter between the fat and abdominal muscles, using a hernia patch, and using laparoscopic techniques. We advocate for using different surgical procedures in obese patients prophylactically to avoid VP shunt failure and distal tube migration in patients with associated risk factors. Keywords: Shunt Complication, Subcutaneous Migration, Ventriculoperitoneal Shunt, Obesity