Upward migration of subduroperitoneal shunt catheters in an infant: a rare complication in the treatment of chronic subdural hematoma

Subduroperitoneal (SP) shunting is widely utilized in treating chronic subdural hematomas (SDHs) in infants, though rare complications such as catheter migration may occur. We present a rare case involving a 3-month-old girl who initially presented with lethargy and increased head circumference. Following a fall, bilateral chronic SDHs and a left parietal skull fracture were diagnosed. Bilateral SP shunts were inserted through the anterior fontanelle without using burr holes. Initial postoperative computed tomography (CT) imaging showed a decrease in the subdural fluid collections. However, at the 2-month follow-up, CT imaging revealed upward migration of both distal catheters from the peritoneal cavity into the subdural space. Consequently, the shunt system was removed, after which the chronic SDHs resolved without further complications. CT imaging at 1-year follow-up demonstrated spontaneous resolution and confirmed normal neurodevelopment. This case underscores an exceedingly rare complication of SP shunting: bilateral upward migration of catheters. Proper anchoring techniques and regular follow-up imaging are crucial for preventing and promptly identifying such complications in very young pediatric patients who undergo SP shunt placement.