Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen
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Department of Surgery, School of Medical Science, Universiti Sains Malaysia, Malaysia
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
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.

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.

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.

None declared.
None declared.
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