Small bowel perforation: a rare complication of ventriculoperitoneal shunt placement

Abstract

Small bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement. When seen, it most commonly affects the stomach or colon. We describe a case and image findings of an 8-year-old female who presented with sepsis and erosion of the VP shunt into the small bowel. The imaging findings were confirmed surgically. We also provide an overview of the current literature discussing previously reported cases, clinical features, and treatment.

Small Bowel Fistulization with Orphaned Intraperitoneal Ventriculoperitoneal Shunt Catheter

“…Other complications include pseudocyst formation, infection, solid organ penetration, and disconnection. 1 In a large retrospective study of nearly 2000 pediatric patients over a 25-year period (with 10-year followup), there were only 19 instances of GI perforation (<1%) with a median of 2.4 years between placement and recognition of hollow viscus perforation. 2 In a review article of 45 case reports available in the literature of GI erosion, 78 per cent of instances occurred in children, with 44 per cent of these patients presenting with passage of the catheter per anus.…”

Lumboperitoneal shunt: a foreign body detected in the small bowel by capsule endoscopy

“…Ventriculoperitoneal or lumboperitoneal shunts have a high rate of complications (23.8 %) [1], of which gastrointestinal complications account for 10 % -30 % [2]. Small-bowel perforation secondary to ventriculoperitoneal shunt is reported in 0.1 % -1 % of cases [3], with a 15 % risk of mortality [4]. Infection and chronic inflammation can lead to perforation of the bowel [2,4], and acute traumatic or foreign body-type allergic reaction to the tubing material has been implicated in some cases [4].…”

“…Small-bowel perforation secondary to ventriculoperitoneal shunt is reported in 0.1 % -1 % of cases [3], with a 15 % risk of mortality [4]. Infection and chronic inflammation can lead to perforation of the bowel [2,4], and acute traumatic or foreign body-type allergic reaction to the tubing material has been implicated in some cases [4]. Patients present asymptomatically, or with abdominal pain, diarrhea, shunt dysfunction, fever, leukocytosis or seizures [4].…”

“…Infection and chronic inflammation can lead to perforation of the bowel [2,4], and acute traumatic or foreign body-type allergic reaction to the tubing material has been implicated in some cases [4]. Patients present asymptomatically, or with abdominal pain, diarrhea, shunt dysfunction, fever, leukocytosis or seizures [4]. The condition often causes peritonitis and other complications such as meningitis, which can be fatal if unrecognized [4], and which may require surgical, endoscopic, or a combination of surgical and endoscopic management [5].…”

“…Patients present asymptomatically, or with abdominal pain, diarrhea, shunt dysfunction, fever, leukocytosis or seizures [4]. The condition often causes peritonitis and other complications such as meningitis, which can be fatal if unrecognized [4], and which may require surgical, endoscopic, or a combination of surgical and endoscopic management [5].…”