Article Figures & Data
Figures
- Figure 1
Computed tomography images of the abdomen showing the distal catheter migration into the stomach: axial view A) and coronal view, B) (white arrow: perforation site; white asterisk: stomach).
- Figure 2
Gastric endoscopy revealing the distal catheter of the shunt perforating the stomach (white arrow: perforation site).
Tables
Dates Relevant past medical history and interventions A past history of communicating hydrocephalus resulting from meningitis had undergone VPS 10 years before admission to the hospital. This first shunt was placed in a different hospital with unknown shunt type. The peritoneal tube (silicon) was placed via open mini-laparotomy. Date Summaries from Initial and Follow-up Visits Diagnostic Testing (including dates) Interventions 2018/8/2 5-day fever • White blood cell count of 11 970/µL and C-reactive protein level of 1.27 mg/dL (2018/8/2) • Start cefmetazole treatment (2018/8/2) • Computed tomographic (CT) scan of brain revealed increased hydrocephalus (2018/8/2) • Revision surgery with replacement of reservoir (2018/8/14) • The glucose and protein level in the cerebrospinal fluid (CSF) were 21 mg/dl and 556 mg/dl (2018/8/14) • The bacterial culture from the intraoperative CSF revealed an infection of oxacillin-sensitive Staphylococcus aureus (2018/8/14) 2018/8/15 Persistent fever • CT images of the abdomen demonstrated that the peritoneal catheter was retained in the stomach (2018/8/15) • Start teicoplanin and cefotaxime treatment (2018/8/19) • Panendoscopy confirmed the presence of peritoneal catheter penetrating the stomach (2018/8/17) • Surgery for the removal of previous VPS following the insertion of the external ventricular drainage. The removal of the peritoneal catheter and gastrorrhaphy were performed through midline open laparotomy by a general surgeon. (2018/8/24) • The bacterial cultures of these tubes revealed the infection of Stenotrophomonas and Entercoccus faecium. (2018/8/24) • Vancomycin and ceftriaxone treatment (2018/8/24~2018/10/9) 2018/10/1 Hydrocephalus without fever • CSF culture revealed no bacterial growth. (2018/9/24) The revision of VPS with burr hole type was performed through left frontal horn of lateral ventricle to left abdomen. The peritoneal shunt was inserted via mini-laparotomy. (2018/10/1) • CSF glucose and protein were 55 mg/dl and 36 mg/dl, respectively. (2018/10/1) 2018/10/9 Discharge without fever; shunt was functional 2019/11/11 No fever; shunt was functional
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