Anal Extrusion of a Ventriculoperitoneal Shunt

Abstract

Ventriculoperitoneal shunt (VPS) placement is an effective and most frequently used surgical method in the treatment of hydrocephalus, but the mechanical and infective complications are often seen after this surgical procedure. Bowel perforation after VPS surgery is rarely seen complication that is reported ranging between 0.1% and 0.7% in the literature. We report a case of 10-month baby who was shunted at day three of her life and has presented to us with protruding distal end of the ventricular catheter through anus. Mechanism of migration of VPS is unclarified yet; nevertheless, children with myelomeningocele have weakness of the bowel muscles, which probably makes it more sensitive for perforation. Additionally, sharp and stiff end of the VPS, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy are other possible reasons of bowel perforation. Peritonitis and ventriculitis have a high morbidity and mortality that may occur after VPS-related bowel perforations; hence, it should be managed rapidly and aggressively to reduce morbidity and mortality.

Ventriculo‐peritoneal shunt perforation of the small bowel

“…While other rare complications involving the small bowel have been well described within the literature, 1,2 we have identified very few cases of shunt tubing erosion directly into the small bowel as opposed to small bowel perforation/injury at the time of shunt insertion. [3][4][5][6] The mechanism in this case is presumed to be chronic irritation and erosion of the shunt tubing into the small bowel, given the normal initial cross-sectional imaging and shunt positioning, leading to recurrent shunt insertion site infections from ascending enteric bacteria.…”