Author(s)
Nicole Molin MD
Lavanya Nagappan MD
Karl Whitley MD
Affiliation(s)
Lewis Katz School of Medicine at Temple University;
Abstract:
Educational Objective: To present a rare case of ventriculoperitoneal shunt (VPS) erosion into the hypopharynx; a presentation that is seldomly reported in the otolaryngology literature. We aim to describe presentation, workup and management.
Objectives: To present a rare case of ventriculoperitoneal shunt (VPS) erosion into the hypopharynx; a presentation that is seldomly reported in the otolaryngology literature. We aim to describe presentation, workup and management.
Study Design: Case study.
Methods: Retrospective chart review.
Results: A 53 year old female with a history of VPS placement for aneurysmal subarachnoid hemorrhage presented 18 months after placement with VPS malfunction and transoral extrusion. CT neck showed migration of the distal shunt tubing through the pyriform sinus. The patient was taken emergently to the operating room for removal under direct visualization. With the help of neurosurgery, the distal VPS tubing was located in the neck clamped and divided. The distal segment was held in place. There was good flow noted through the more proximal end of the tubing and new distal shunt tubing was connected. The distal tubing was then directly visualized in the hypopharynx via direct laryngoscopy. The tubing was slowly withdrawn under direct visualization as it was released from the neck until the tubing was completely removed. The pharynx, hypopharynx and larynx were inspected without any serious violation. The patient remained in the neurosurgical ICU on a prolonged course of antibiotics and close observation for signs of mediastinitis. An esophagram POD10 showed no evidence of a leak prior to oral intake.
Conclusions: VPS erosion into the airway is a rare event. Management should be prompt and in conjunction with neurosurgery. Removal under direct visualization allows for inspection of the erosion site which can help guide management.