====== Ventriculoperitoneal shunt disconnection risk factors ======

Cervical motion and growth might characterize the chief factors leading to shunt system discontinuity 
((Sathyanarayana S, Wylen EL, Baskaya MK, Nanda A (2000) Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases. Surg Neurol 54(5): 388-396.)).

[[Disconnection]] of [[ventriculoperitoneal shunt]] (VPS) catheter is observed more in multicomponent [[shunt]] [[system]]s
((Hinojosa J. Complications of peritoneal shunts. In: Di Rocco C, Turgut M, Jallo G, Martínez-Lage J, editors. Complications of CSF Shunting in Hydrocephalus: Prevention, Identification, and Management. Switzerland: Springer International Publishing; 2015. pp. 187–202.))
((Kinasha AD, Kahamba JF, Semali IT. Complications of ventriculoperitoneal shunts in children in Dar es Salaam. East Cent Afr J Surg. 2005;10:55–9.)).

In multisegment VPS systems, the weakest points for [[shunt disconnection]] are connector site, connector to the [[ventricular catheter]], and [[connector]] to [[chamber]] site. The causes for shunt disconnection in the multisegment VPS system are excessive [[traction]] movements at the cranial end, poor [[fixation]] at the [[cranial]] site, and [[break]] in [[ligature]]s. VPS disconnection is not always associated with [[shunt malfunction]], and in such cases, the entire VPS system can be safely removed. VPS system disconnection associated with other [[ventriculoperitoneal shunt]] [[complications]] that occurred in the same patient at the same time has also been reported in the [[literature]]
((Lo WB, Ramirez R, Rodrigues D, Solanki GA. Ventriculoperitoneal shunt disconnection associated with spontaneous knot formation in the peritoneal catheter. BMJ Case Rep. 2013 May 22;2013:bcr2013009590. doi: 10.1136/bcr-2013-009590. PMID: 23704448; PMCID: PMC3669854.))
((Haddadi K, Qazvini HR, Sahebi M. Ventriculoperitoneal shunt disconnection associated with loss of consciousness in a child patient: A case report and review of intra-abdominal complications of VP shunts. J Neurol Stroke. 2017;7:00237.)).

Disconnections in the system accounted for 41 (15%) of the malfunctions. The more distal the connection was from the ventricle, the higher the likelihood of disconnection. Furthermore, occipitally placed shunts had a significantly higher tendency to dislocate than frontally placed shunts.
((Aldrich EF, Harmann P. Disconnection as a cause of ventriculoperitoneal shunt mal-function in multicomponent shunt systems. Pediatr Neurosurg 1990; 16: 309-311.)).

11% in the series of Stone et al.
((Stone JJ, Walker CT, Jacobson M, Phillips V, Silberstein HJ. Revision rate of 
pediatric ventriculoperitoneal shunts after 15 years. J Neurosurg Pediatr. 2013
Jan;11(1):15-9. doi: 10.3171/2012.9.PEDS1298. Epub 2012 Oct 26. PubMed PMID:
23101557.)).

High tension is sometimes caused in the shunt tube between the two anchor point viz., head and chest wall due to movement of the neck or growth and may induce such dislocation and disconnection of the shunt tube
((Tsurushima H, Harakuni T, Saito A, Hyodo A, Yoshii Y. Shunt tube problems due to place-ment of valves on the chest wall–three case reports. Neurol Med Chir 2000; 40: 342-344.)).