CASE REPORT
Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen
 
More details
Hide details
1
Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Malaysia
2
Department of Physiology, School of Medical Sciences, Universiti Sains Malaysia, Malaysia
Submission date: 2020-05-12
Final revision date: 2020-10-02
Acceptance date: 2020-10-02
Online publication date: 2021-06-07
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Ventriculoperitoneal shunt (VPS) is most commonly performed surgical treatment for hydrocephalus by draining excessive cerebrospinal fluid (CSF) in ventricles to peritoneal cavity. Despite significant improvement in shunt procedure and being a relatively simple procedure, shunt complications remain common.

Aim:
The aim of this paper is to report a case of perforated bowel presented with silence abdomen following VPS insertion.

Case study:
We report a case of protrusion of distal VPS catheter through anus with silent abdomen, managed successfully with minimal intervention. Patient, 11-months-old male infant, diagnosed with congenital communicating hydrocephalus and VPS placement was done at 6 months of life, presented with tip of VPS protruding from anus after 4 months of VPS insertion. Patient was scheduled for removal of VPS, where shunt was disconnected through superficial abdominal incision, distal portion removed through anus without resistance. Postoperative patient recovers well without abdominal complication.

Results and discussion:
Perforation of bowel by distal peritoneal catheter is rare and only accounts for 0.1%–0.7% of complication. The exact pathogenesis for spontaneous bowel perforation is unclear. Management of bowel perforation secondary to VPS is highly individualized, mainly depending on its clinical symptoms and signs.

Conclusions:
Although bowel perforation following VPS insertion is rare, it carries high mortality up to 15% especially if unrecognized and delayed in treatment. Early detection and appropriate management are key in reducing VPS related morbidity and mortality.

FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
 
REFERENCES (14)
1.
Carey C, Tullous M, Walker M. Hydrocephalus: Etiology, pathologic effects, diagnosis and natural history. In: Cheek WR, Marlin AE, McLone DG, Reigel DH, Walker ML, eds. Pediatric Neurosurgery. Surgery of the Developing Nervous System. 3rd ed. Philadelphia: WB Saunders. 1994;185–201.
 
2.
Lee BS, Vadera S, Gonzalez-Martinez JA. Rare complication of ventriculoperitoneal shunt. Early onset of distal catheter migration into scrotum in an adult male: Case report and literature review. Int J Surg Case Rep. 2015;6C:198–202. https://doi.org/10.1016/j.ijsc....
 
3.
Weprin B, Swift D. Complications of Ventricular Shunts. Tech Neurosurg. 2002;7(3):224–242. https://doi.org/10.1097/001279....
 
4.
Wu Y, Green NL, Wrensch MR, Zhao S, Gupta N. Ventriculoperitoneal shunt complications in California: 1990 to 2000. Neurosurg. 2007;61(3):557–562. https://doi.org/10.1227/01.neu....
 
5.
Ezzat AAM, Soliman MAR, Hasanain AA, et al. Migration of the distal catheter of ventriculoperitoneal shunts in pediatric age group: Case series. World Neurosurg. 2018;119:e131–e137. https://doi.org/10.1016/j.wneu....
 
6.
Harischandra L, Sharma A, Chatterjee S. Shunt migration in ventriculoperitoneal shunting: A comprehensive review of literature. Neurol India. 2019;67(1):85–99. https://doi.org/10.4103/0028-3....
 
7.
Snow RB, Lavyne MH, Fraser RA. Colonic perforation by ventriculoperitoneal shunts. Surg Neurol. 1986;25(2):173–177. https://doi.org/10.1016/0090-3....
 
8.
Paff M, Alexandru-Abrams D, Muhonen M, Loudon W. Ventriculoperitoneal shunt complications: A review. Interdiscip Neurosurg. 2018;13:66–70. https://doi.org/10.1016/j.inat....
 
9.
Brownlee JD, Brodkey JS, Schaefer IK. Colonic perforation by ventriculoperitoneal shunt tubing: A case of suspected silicone allergy. Surg Neurol. 1998;49(1):21–24. https://doi.org/10.1016/s0090-....
 
10.
Thiong’o GM, Luzzio C, Albright AL. Ventriculoperitoneal shunt perforations of the gastrointestinal tract. J Neurosurg Pediatr. 2015;16(1):36–41. https://doi.org/10.3171/2014.1....
 
11.
Ibrahim AWM. E. coli meningitis as an indicator of intestinal perforation by V-P shunt tube. Neurosurgl Rev. 1998;21(2):194–197. https://doi.org/10.1007/bf0238....
 
12.
Digray NC, Thappa DR, Arora M, Mengi Y, Goswamy HL. Silent bowel perforation and transanal prolapse of a ventriculoperitoneal shunt. Pediatr Surg Int. 2000;16(1–2):94–95. https://doi.org/10.1007/s00383....
 
13.
Chiang L-L, Kuo M-F, Fan P-C, Fan B-J, Hsu W-M. Transanal Repair of Colonic Perforation due to Ventriculoperitoneal Shunt-Case Report and Review of the Literature. J Formos Med Assoc. 2010;109(6):472–475. https://doi.org/10.1016/s0929-....
 
14.
Sathyanarayana S, Wylen EL, Baskaya MK, Nanda A. Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: Case report and a review of 45 cases. Surg Neurol. 2000;54(5):388–396. https://doi.org/10.1016/s0090-....