Asymptomatic perforation of large bowel and urinary bladder as a complication of ventriculoperitoneal shunt: Report of two cases

Abstract

Insertion of a VP shunt represents the most frequent method of choice of the surgical treatment of hydrocephalus, but also potentially a highly risky procedure followed by various complications about which parents should be informed when patients are children. Owing to adequate approach in the follow-up of children with implanted VP shunt, large bowel and urinary bladder perforation, examples of severe and potentially fatal complications of this surgical intervention, could be disclosed on time and adequately resolved.

An Acute Complication of Ventriculoperitoneal Shunt with Bladder Perforation and Extrusion through the Urethra in a Newborn: Case Report and Review of the Literature

“…In our case this complication occurred only 1 day after the VPS implantation as an acute complication of this procedure. This complication has been more commonly reported in childhood [1,2,3,6,7,8,9,10,11,12,15,16,17,18] but it has also been described in adulthood [4,13,14,19]. Although this complication has not been reported in the neonatal period in the literature, our patient was a neonate.…”

“…We found only 23 cases of VPS complication with bladder perforation with or without extrusion through the urethrain the literature. These are summarized in table 1[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. …”

Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature

“…Based on our case and a literature review, we stress the following issues: (a) the importance of early diagnosis and treatment to minimize or prevent infectious and neurological complications [7,35], (b) the externalization of the proximal edge of the shunt without pulling the distal tip proximally by cutting the distal shunt tube over the abdominal wall and pulling the distal edge from the anal side to prevent the spread of infection spread, (c) the application of broad spectrum antibiotics until the CSF cultures are negative, and (d) the focus of attention on the abdominal symptoms and signs.…”

“…Since that time, 15 cases have been reported [7,8,[12][13][14][15][16][17][18][19][20][21][22][23]. In total, there are 112 cases including our case.…”

“…The first case of bowel perforation was reported in 1966 [5]. The shunt abdominal catheter may protrude from the large bowel [6], urinary bladder [7], urethra [8], or even the oral cavity [9]. The most common perforation site is the colon [10].…”