Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases

S, Satish; Wylen, Esther L.; Başkaya, Mustafa K.; Nanda, Anil

doi:10.1016/s0090-3019(00)00334-7

Cited by 175 publications

(209 citation statements)

References 14 publications

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“…7,25,27,32 In our series, 3% of 197 shunt complications were perforations of the GI tract by Chhabra shunts, a perforation frequency substantially higher than the frequency associated with other shunts. That high percentage of perforation has not been reported for shunts from other manufacturers and raised the possibility that perforations were related to stiffness of Chhabra shunts.…”

Section: Discussionmentioning

confidence: 47%

“…The incidence of VP shunts perforating the GI tract has been reported to be between 0.1% and 0.7%. 7,25,27,32 If a shunt perforates the GI tract, it migrates most often caudally thereafter to protrude through the anal orifice, but has been reported to migrate upward and protrude through the oral cavity. 2,5,6,9,15,21,23,27,29 More than 50% of VP shunt protrusions occur in patients less than 10 years of age.…”

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confidence: 99%

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Ventriculoperitoneal shunt perforations of the gastrointestinal tract

Thiong’o

Luzzio

Albright

2015

PED

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OBJECT The purposes of this study were to evaluate the frequency with which children presented with ventriculoperitoneal (VP) shunt perforations of the gastrointestinal (GI) tract, to determine the type of shunts that caused the perforations, and to compare the stiffness of perforating catheters with the stiffness of catheters from other manufacturers. METHODS Medical records were reviewed of 197 children who were admitted with VP shunt malfunction. Catheter stiffness was evaluated by measuring relative resistance to cross-sectional compression, resistance to column buckling, and elasticity in longitudinal bending. Catheter frictional force was measured per unit length. RESULTS Six children were identified whose VP shunts had perforated the GI tract; 2 shunts subsequently protruded through the anal orifice, 1 protruded through the oral cavity, and 3 presented with subcutaneous abscesses that tracked upward from the intestine to the chest. All perforating shunts were Chhabra shunts. Catheter stiffness and resistance to bending were greatest with a Medtronic shunt catheter, intermediate with a Codman catheter, and least with a Chhabra catheter. Frictional force was greatest with a Chhabra catheter and least with a Medtronic catheter. CONCLUSIONS The frequency of perforations by Chhabra shunts appears to be higher than the frequency associated with other shunts. The increased frequency does not correlate with their stiffness but may reflect their greater frictional forces.

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Section: Discussionmentioning

confidence: 47%

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confidence: 99%

Ventriculoperitoneal shunt perforations of the gastrointestinal tract

Thiong’o

Luzzio

Albright

2015

PED

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“…12) A review of the literature up to 2000 identified 45 similar cases. 6) In our patient, mechanical ileus, caused by duplication of the terminal ileum, resulted in continuous irritation of a fixed point on the bowel surface and finally perforation of the sigmoid colon. At the first operation, shuntgraphy revealed perforation of the abdominal catheter into the intestine.…”

Section: Discussionmentioning

confidence: 64%

“…Complications associated with this invasive procedure include disconnection, breaking and kinking of the tube, tip occlusion of the tube, cerebrospinal fluid (CSF) loculation, shunt infection, intestinal obstruction, migration of the shunt, and perforation of the internal organs. 2,4,11) Perforation of the colon is a very rare complication, occurring in less than 0.1% of patients, 6) and the mortality rate is approximately 15%. 8) The period between shunting and discovery of the bowel perforation varies from 2 months to 7 years.…”

Section: Introductionmentioning

confidence: 99%

Transanal Prolapse of a Ventriculoperitoneal Shunt Catheter -Case Report-

Matsuoka

Takegami

Maruyama

et al. 2008

Neurol. Med. Chir.(Tokyo)

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A 4-year-old girl presented with asymptomatic bowel perforation and transanal protrusion of a ventriculoperitoneal (VP) shunt catheter. She had undergone repair of myelomeningocele at birth and subsequent VP shunting for congenital hydrocephalus 1 month later. Seven months after VP shunting, she underwent revision of the peritoneal catheter. She complained of abdominal pain and nausea at the age of 4 years. She was treated conservatively for 1 month for intestinal obstruction. One month later, her mother noticed the shunt catheter protruding from her anus. Computed tomography (CT) of the abdomen revealed that the peritoneal catheter had migrated into the colon, and CT of the head showed symmetrical dilation of the ventricles. The shunt system was removed immediately, repair of the fistula in the sigmoid colon was performed, and external ventricular drainage was continued for 6 weeks until shunt replacement. One month after the first operation, intestinal obstruction recurred. Duplication of the terminal ileum was removed to prevent further recurrence of the intestinal obstruction. She underwent ventriculoatrial shunting 2 weeks after the second operation and was discharged without neurological sequelae.

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“…Large intestine is considered the most frequent site of perforation due to VP shunt with an incidence of 0.1-0.7% [11]. The first case of anal extrusion of distal VP shunt was reported by Wilson and Bertrand in 1966 [12].…”

Section: Discussionmentioning

confidence: 99%