Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature

Abstract

<jats:title>Abstract</jats:title><jats:p>Bowel perforation by a peritoneal catheter (BPPC) is a serious complication after ventriculoperitoneal shunting, with high mortality and morbidity rates. This patient presented with scalp ulceration over the shunt valve at the retromastoid region 26 years after shunt placement. During revision, the catheter distal to the valve was divided in the clavicular region. As there was no cerebrospinal fluid drainage, we decided to remove the ventricular catheter and valve. The ulceration was debrided and primarily closed. Distal to the clavicle, the disconnected peritoneal catheter was encased in a fibrous, calcified tunnel. To avoid piecemeal resection with multiple incisions, the catheter was not retrieved. Two years later, the patient presented with an abscess and pus draining from the clavicular wound. Cultures were positive for enteric bacteria. BPPC with retrograde spread of infection was suspected, and abdominal computed tomography confirmed perforation. We removed the disconnected catheter, but the perforation site could not be detected during laparotomy. The patient was treated with intravenous antibiotics and recovered without complications. To minimize complications, abandoned catheters should be avoided. Otherwise, patients unnecessarily have a life-long risk of developing abdominal complications. In patients with abandoned catheters and severe abdominal symptoms, BPPC is an important differential diagnosis.</jats:p>

Early Anal Protrusion of Distal Ventriculoperitoneal Catheter Due to Iatrogenic Colonic Perforation: A Case Report and Review of Literature

“…Since the infant in that mentioned case had no prior history of any infection in the peritoneal cavity, the first operation of shunt insertion likely has resulted in these adhesions. It has also been suggested that children with congenital conditions such as myelomeningocele and congenital hydrocephalus could be more prone to developing perforation of the bowel due to friable bowel wall possibly caused by the deficient innervation [9][10][11][12][13]. Also, it has been demonstrated that catheters may cause allergies to people with silicone allergies and cause perforation with intestinal irritation and adhesion.…”

“…However, protrusion of the tip of the distal catheter from the anal canal is the most frequent presentation of symptomatic bowel perforation. About 15% to 25% or less of documented cases diagnosed with intestinal perforation also had signs of peritonitis, while 43% to 48% either developed ventriculitis or meningitis [9][10][11][12][13][14][15][16][17].…”

“…Many researchers have proposed the formation of fibrosis that encases part of the catheter. This fibrosis is suspected to cause some pressure on the distal catheter, resulting in that area of the bowel being ulcerated, which eventually leads to bowel perforation [ 12 ]. It is also suggested that this mechanism of perforation is mainly caused by repetitive mechanical irritation by the stiff distal catheter to the small bowel due to peristalsis [ 12 ].…”

“…This fibrosis is suspected to cause some pressure on the distal catheter, resulting in that area of the bowel being ulcerated, which eventually leads to bowel perforation [ 12 ]. It is also suggested that this mechanism of perforation is mainly caused by repetitive mechanical irritation by the stiff distal catheter to the small bowel due to peristalsis [ 12 ]. In a reported case by Bakal, adhesions have been noticed in between the colon and the distal catheter at or near the site of perforation [ 13 ].…”