Migration of the peritoneal tip of a ventriculoperitoneal catheter causing shunt malfunction
Bibliographic record
Abstract
This 6-year-old boy presented with a short history of headache, nausea, and vomiting. He was born prematurely at 24.5 weeks of gestational age and suffered an intraventricular hemorrhage causing hydrocephalus. A ventriculosubgaleal shunt was inserted 4.5 months later, which was converted after 1 month to a ventriculoperitoneal shunt with a medium-pressure valve. The peritoneal catheter was placed using a trocar; no purse-string suture was placed around the opening. An intraoperative lateral radiograph of the abdomen confirmed intraperitoneal placement of the catheter. The shunt was revised twice at the upper end. The last revision had been 3 years prior to presentation, when the valve was changed to an Orbis Sigma valve (Integra NeuroSciences; Sophia Antipolis, France). Upon admission to our institution, the boy was lethargic but otherwise normal neurologically. A computed tomography scan of his head showed no change in ventricular size (Fig. 1), and radiographs of the shunt were nondiagnostic. The patient’s neurological condition subsequently deteriorated, necessitating a shunt revision. During the surgery, the ventricular end was found to be working, but the peritoneal catheter was blocked. When the abdominal wound was opened, the shunt was found to be tracking back along the shunt track. The peritoneal end was removed and a new catheter was inserted via a new abdominal opening into the peritoneum. The patient recovered, and his symptoms resolved immediately. On reviewing the radiographs of the shunt retrospectively, they were found to show the backtracking of the shunt clearly (Fig. 2 upper). Radiographs of the shunt obtained 1 year previously had shown normal findings (Fig. 2 lower). Retrograde migration of a shunt in the same track is rare; one case of its occurrence in a 1-year-old patient has been previously reported. 1 In that case it was hypothesized to be due to a combination of excess catheter, a small peritoneal cavity, and an opening in the peritoneum that was not in a purse-string configuration around the catheter. The mechanism of the migration in our case remains unclear, but a lateral radiograph would have indicated clearly that the shunt catheter was extraperitoneal. 1
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.006 | 0.006 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".