Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature

Abdul, Hai; Rab, Atia Zakaur; Ghani, Imran; Huda, Muhammad F; Quadir, Abdul

doi:10.4103/0971-9261.74521

Cited by 51 publications

(33 citation statements)

References 16 publications

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“…The peritoneal end of the VP shunt has been associated with complications such as mechanical blockade by omentum leading to shunt failure, pseudocyst formation, intestinal volvulus, inguinal hernia, perforations of hollow viscus, penetration into solid organs & abdominal wall and protrusion outside body [2].…”

Section: Discussionmentioning

confidence: 99%

Unusual Ventriculoperitoneal (VP) Shunt Tube Extrusion through Anus in a Child with Dandy Walker Malformation: A Rare Case Report

2015

JCDR

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We report a case of a one year female who presented to us with extrusion of ventriculoperitoneal (VP) shunt catheter through anus. The child was brought to us with complaint of swelling over nape of the neck at 12 days of life when she was diagnosed as a case of Dandy walker malformation with large subtorcular occipital meningocoel [Table/ Fig-1] for which she went underwent excision. The child later developed hydrocephalus at six months of age for which a ventriculo peritoneal shunt was done and the child was discharged in a satisfactory condition.Six months later the child was brought back to us with complaint of shunt tube protruding through anus and was draining clear cerebrospinal fluid [Table/ Fig-2]. On admission, she was conscious, active, and neurologically normal, with depressed anterior fontanalle and without signs of meningitis. Her abdomen was soft without any abnormality.The child was taken to operation theatre and the distal end of the catheter was pulled out through the rectum after division of the shunt just below the reservoir ( this was done to avoid catheter track contamination ) and the ventricular end was send for culture and sensitivity. This was followed by intravenous antibiotics in anti aBstRaCt Aim of this paper is to report a case of extrusion of Ventriculo peritoneal shunt tube through anus in a one year female child ( k/c/o dandy walker malformation ) treated with placement of ventriculo peritoneal shunt for post operative hydrocephalus after excision of Subtorcular occipital meningocoel. The exact cause of such extrusion is not known. Unusual migration of distal catheter tip of VP shunt is a rare and bowel perforation is reported to occur between 0.1% and 0.7%. The possible factors responsible for this complication are thin bowel wall in children, sharp and stiff end of the VP shunt, use of trocar by some surgeons, chronic irritation by the shunt, previous surgery, infection and silicone allergy. In view of the potential for meningitis prompt and aggressive management is essential to avoid morbidity and mortality.keywords: Extrusion through anus, Hydrocephalus, Meningocoel, Ventriculoperitoneal shunt meningitic doses. The child was observed carefully and an external ventricular drain was put once the anterior fontanalle started bulging on second postoperative day despite anti oedema medication. The plan was to reinsert new VP shunt once the culture reports were obtained. The ventricular end was sterile on culture. But the child was discharged against medical advice and was lost to follow up.

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Section: Discussionmentioning

confidence: 99%

Unusual Ventriculoperitoneal (VP) Shunt Tube Extrusion through Anus in a Child with Dandy Walker Malformation: A Rare Case Report

2015

JCDR

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“…In a recently published review by Hai et al [11], anal protrusions of distal shunt catheters were reported in 96 patients. Since that time, 15 cases have been reported [7,8,[12][13][14][15][16][17][18][19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Because the bowel perforation caused by the shunt is usually very small, in most of the cases, it would seals by itself. Thus, laparotomy is rarely necessary and is indicated only for those patients who present with acute abdomen [11,29,30].…”

Section: Discussionmentioning

confidence: 99%

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

Liu

Tian

2017

Chin Neurosurg Jl

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Background: Ventriculo-peritoneal shunting is an effective treatment for hydrocephalus, bowel perforation by peritoneal catheters is an extremely rare complications associated with this procedure. Case presentation: We report a 9-year-old girl who had anal VP shunt protrusion two months following surgery and review the literature to understand the diagnosis and treatment for this rare complication. A PubMed search using the keywords 'bowel perforation' and 'Escherichia coli ventriculitis' was performed and citations were reviewed. Conclusions: Neurosurgeons should be alert to early diagnosis and appropriate treatment of this condition to prevent infectious and neurological complications.

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“…Diagnosis is obvious when anal or oral protrusion of the catheter occurs, but some situations should raise the suspicion of this complication, namely ventriculitis or meningitis due to an "unusual" enteric organism, such gram-negative or anaerobic, or a CT scan showing pneumocephalus without another cause [3,7] . This patient had 2 episodes of acute meningitis due to E. coli a very long time after VPS placement (28 years).…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of a VPS perforating the bowel must be individualized, taking into account the clinical presentation [3,4,7,8] . Three principles are important: external drainage of the proximal part until the cerebrospinal fluid is biochemically near-normal and sterile on culture, intravenous antibiotics, and removal of the perforating part of the catheter [2,3] .…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Colonic Perforation due to Ventriculoperitoneal Shunt: Case Report and Literature Review

Alves

Mendes

Lopes

et al. 2017

GE Port J Gastroenterol

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Abordagem endoscópica de perfuração do cólon por cateter de derivação ventrículo-peritoneal: caso clínico e revisão da literatura Palavras Chave Derivação ventrículo-peritoneal · perfuração cólica · colonoscopia ResumoOs autores descrevem o caso de uma mulher de 42 anos com perfuração do cólon por cateter de derivação ventrí-culo-peritoneal (DVP) colocado 28 anos antes. No contexto de meningite aguda a Escherichia coli , o estudo complementar com tomografia computadorizada abdominal identificou a extremidade distal do cateter de DVP no interior do lúmen do cólon esquerdo. Após remoção da extremidade ventricular do cateter, optou-se pela tentativa de extração da extremidade intra-cólica por colonoscopia. Durante a extração do cateter com ansa de polipectomia, constatou-se secção do mesmo no local de entrada na parede cólica, observando-se um pequeno orifício. Keywords Ventriculoperitoneal shunt · Intestinal perforation · Colonoscopy AbstractThe authors report the case of a 41-year-old woman with a colonic perforation due to a ventriculoperitoneal shunt (VPS) catheter. Left-sided colonic perforation was diagnosed by abdominal computed tomography 28 years after shunt placement, following acute meningitis caused by Escherichia coli . The proximal end of the VPS was exteriorized and it was decided to remove the distal end by colonoscopy. After pulling out the catheter with a polypectomy snare, it broke at the site where it was entering the colon, leaving a small perforation in the colonic wall which was closed with 2 endoclips. The endoluminal fragment of the catheter, being 20 cm in length, was removed through the rectum. The patient is asymptomatic at the 12-month follow-up. A review of the literature regarding 9 endoscopically managed cases of digestive tract perforation caused by VPS is presented. Procedeu-se ao encerramento da perfuração com 2 endoclips e extração do fragmento livre endoluminal do cateter, com cerca de 20 cm, pelo reto. A doente permanece assintomática após 12 meses de seguimento. Uma revisão da literatura identificou 9 casos de perfuração do tubo digestivo por cateter de DVP tratados com endoscopia.

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Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature

Cited by 51 publications

References 16 publications

Unusual Ventriculoperitoneal (VP) Shunt Tube Extrusion through Anus in a Child with Dandy Walker Malformation: A Rare Case Report

Unusual Ventriculoperitoneal (VP) Shunt Tube Extrusion through Anus in a Child with Dandy Walker Malformation: A Rare Case Report

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

Endoscopic Management of Colonic Perforation due to Ventriculoperitoneal Shunt: Case Report and Literature Review

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