Complete Intestinal Obstruction and Necrosis as a Complication of a Ventriculoperitoneal Shunt in Children

Abstract

Ventriculoperitoneal (VP) shunt complications are common, but abdominal complications are rare. The objective of this report is to present 2 cases of intestinal obstruction due to a VP shunt and review the literature for data on this rare occurrence.A 4-month-old boy received surgical resection of a medulloblastoma and a VP shunt was inserted to manage progressive hydrocephalus. Two months later, he was admitted with intermittent vomiting, and plain abdominal radiography showed complete intestinal obstruction. Emergency laparotomy revealed an adhesive intestinal obstruction around the catheter, and approximately 5 cm of necrotic ileum was resected. His recovery was uneventful. In the second case, a 6-year-old boy was diagnosed with a primary nongerminomatous malignant germ cell tumor and a VP shunt was place to treat hydrocephalus. Two weeks after the first course of chemotherapy, he went into a coma; computed tomography demonstrated enlargement of the tumor and gross total resection was performed. Two weeks later, he developed abdominal distention; plain radiography showed intestinal obstruction and laparotomy revealed adhesive intestinal obstruction around the catheter with 15 cm of necrotic ileum. The necrotic bowel was resected. Unfortunately, the patient developed sepsis and despite treatment remained in a vegetative state.Medline, Central, Embase, and Google Scholar databases were searched up to May 9, 2014, using the terms VP shunt, shunting, and/or intestinal obstruction. Only cases involving children or adolescents were included. Eleven reports involving patients with abdominal complications resulting from a VP shunt for hydrocephalus were identified. The dates of the reports spanned from 1971 to 2014. Volvulus was the most common cause of VP shunt-related obstruction, and mechanical obstruction due to twisting of the catheter the second most common. Only 1 case in the literature review was related to intestinal adhesions. Treatment in most cases was laparotomy.Although intestinal obstruction is a rare complication of a VP shunt, it should be considered in the presence of abdominal symptoms and prompt treatment provided to have a good outcome.

A rare case of ventriculoperitoneal shunt knot causing intestinal obstruction in an adult

“…7 Till date, there are a limited number of case reports available and only 15 cases of intraperitoneal knot formation with intestinal obstruction have been described in literature. 8 The time interval from shunt placement to development of features of intestinal obstruction varied widely. Most of the times mechanical obstruction occurred during removal of the abdominal end of the catheter as a loop of the shunt tightened around the bowel loop.…”

Fatal Complications after Pediatric Surgical Interventions: Lessons Learned

“…Ventriculoperitoneal shunts (VPSs) and drains can luxate, can cause infections, or can migrate into organs,thus causing complications. The overall complication rate of VPS is very high (50%), mainly including infection and obstruction 11. We present three cases with fatal outcomes after placement of a drain, a tube, and a shunt.…”

If It’s Not Broken, Should We Fix It? Ventriculoperitoneal Shunt Catheter Contributing to Closed-Loop Small Bowel Obstruction in a Pediatric Patient with Ileostomy

“…The remaining VP shunt catheter was repositioned in the peritoneal cavity. The postoperative clinical course was unremarkable with no VP shunt-related complications.Bowel obstruction, necrosis, and perforation are known but rare complications of VP shunt catheters [1][2][3]. Our case highlights a unique neurosurgical dilemma of whether or not to offer surgical intervention for a non-/ malfunctioning VP shunt to a patient who presented with symptoms of partial small bowel obstruction likely worsened by circumferential compression of the small bowel by VP shunt tubing (as shown in imaging).…”