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Management dilemma in Thoracoamniotic Shunt Migrations
  1. Audrey Poh Poh Tan1,
  2. Bobby Tan1,
  3. Ann Wright2 and
  4. Juin Yee Kong3
  1. 1KK Women's and Children's Hospital, Singapore
  2. 2Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
  3. 3Neonatology, KK Women's and Children's Hospital, Singapore
  1. Correspondence to Dr Juin Yee Kong; kong.juin.yee{at}singhealth.com.sg

Abstract

Shunt migration is a rare but significant complication of thoracoamniotic shunting, an intervention widely used for fetal pleural effusion. We describe a case of a term infant noted antenatally to have fetal hydrothorax that was managed with thoracoamniotic shunting but complicated by shunt migration. We also present the current literature on risk factors, complications and management of intrathoracic shunt migration. The majority of shunt migration cases are managed conservatively with no untoward postnatal sequelae, but surgical removal of the migrated shunt has been used for associated clinical complications, if visceral damage is suspected or if postnatal thoracic surgery is indicated for other reasons. We advocate an approach of conservative management for asymptomatic infants, where possible, to avoid unnecessary surgical and anaesthetic risks to very young, often already compromised children. However, further studies are still required to determine optimal management after shunt migration has occurred to ensure the best outcome.

  • paediatric surgery
  • materno-fetal medicine
  • neonatal and paediatric intensive care

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Footnotes

  • Contributors JYK conceptualised the study. APPT and BT wrote the manuscript with the support of AW and JYK.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.