Staged operations for posthemorrhagic hydrocephalus in extremely low-birth-weight infants with preceding stoma creation after bowel perforation: surgical strategy

We report a complicated extremely low-birth-weight (ELBW) infant with posthemorrhagic hydrocephalus after intraventricular hemorrhage and preceding stoma creation after bowel perforation who was treated with staged operations, including shunting and external ventricular drainage. The first operation was a temporary valveless ventriculoperitoneal (VP) shunt placement until the time of the stoma closure. The stoma was successfully closed 3 months after the first operation when the peritoneal tube was drawn out from the chest wall and the VP shunt system was temporarily used as an external drainage with a long subcutaneous tunnel. One month after the second operation, final VP shunt placement was performed after good healing of bowel anastomosis was surely confirmed. The previous peritoneal shunt tube was cut behind the ear, removed, and replaced with a valve-regulated VP shunt system. This staged strategy is a safe and feasible option for complicated ELBW infants with preceding stoma and hydrocephalus.