Bowel perforation by lumbar-peritoneal (LP) shunt: A rare complication of neurosurgery

Abstract

HighlightsLumbar-peritoneal (LP) and ventriculo-peritoneal (VP) shunt placement is the treatment of choice for diversion of cerebrospinal fluid (CSF) from the subarachnoid space into the peritoneal cavity.Perforation of the bowel by lumbar-peritoneal or ventriculo-peritoneal shunt is an extremely rare complication.We report a case of a 72 old female patient with LP shunt for raised intracranial pressure, who presented with LP shunt catheter protruding from anus.She was surgically treated with removal of the distal part of the shunt, external drainage of the proximal part and primary closure of the perforation.

Duodenal perforation as a postoperative complication after ventriculoperitoneal shunt: A case report

“…Abdominal complications account for 10–30% including various types such as occlusive/mechanical (15%), infections (5%), cyst formation (1–2%), and visceral perforation (0.2–0.3%) [ 1 , 2 ]. The catheter can migrate into the intestine, stomach, bladder, vagina, scrotum, penis, navel [ 3 , 4 , [5] , [6] , [7] , [8] , [9] , [10] , [12] , [13] , [14] ]. Intestinal perforations are very rare: 0.01–0.07% of abdominal complications [ 2 , 12 , 18 ], and mortality due to these complications can be up to 15% (mostly due to infection) [ 2 , 3 ].…”

“…However, some authors believe that this complication is often observed in young children due to a thin, easily punctured intestinal wall [ 6 ]. Most cases of a catheter that entering into the intestine are diagnosed when the tube was found outside of the anus [ [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , 13 , [15] , [16] , [17] , [18] , [19] ] or the mouth [ 14 , 15 ], or comes out of the penis and navel [ 15 , 17 ]. In cases where the tube does not come out (anus, mouth, penis, vagina, etc.…”

A unique strategy for large-bowel perforation with ventriculoperitoneal shunt: Conversion to ventriculoatrial shunt: A case report

“…Peritonitis, intraperitoneal abscess, and sepsis should always be treated with exploratory laparotomy, lavage, primary bowel-wall closure, and shunt removal [4,8]. The ventricular part should be drained for at least 14 days, with antibiotic treatment as prophylaxis [4,10]. Once CSF cultures are repeatedly negative, a new peritoneal shunt catheter can be placed at the opposite site [10].…”

“…The ventricular part should be drained for at least 14 days, with antibiotic treatment as prophylaxis [4,10]. Once CSF cultures are repeatedly negative, a new peritoneal shunt catheter can be placed at the opposite site [10].…”

“…Although total shunt replacement more reliably eliminates infection sources, shunt resection at the subclavian level and its ventricular end still remains controversial. However, multiple ventricular punctures may confer risk of choroidal hemorrhage and intra-abdominal adhesion after bowel perforation and can interfere with safe shunt revision [10]. Although definitive criteria to evaluate the risk of shunt-transmitted CNS infection are lacking, CSF analysis, including culturing, was performed on the 3rd, 5th, and 10th days postoperatively; results revealed no evidence of infection; thus, the possibility of CNS infection was excluded.…”