A rare case of colon perforation complicating a vetriculoperitoneal shunt with trans-anal protrusion
Background: Ventriculoperitoneal (VP) shunt placement is an effective treatment of hydrocephalus diverting the cerebrospinal fluid into the peritoneal cavity. Colon perforation and spontaneous extrusion of the lower end of the tube through the anal opening is a rare and unusual complication of the ventriculoperitoneal shunt.
Case study: We report a case of 11 years old girl with the shunt tubing protruding through the anus associated with spontaneous colon perforation. This complication occurred 10 years following insertion of ventriculoperitoneal shunt for congenital hydrocephalus. There were no signs of meningitis and mild tenderness present over abdomen. At laparotomy the tube was seen to enter the descendens colon and was encapsulated by the greater omentum. The tube was cut and the distal end removed via the anus. The descendens colon was repaired. The catheter continued to function effectively and the patient remained asymptomatic.
Conclusion: Colon perforation and transanal extrusion of VP shunt catheter is a rare but serious problem. The results of abdominal complications of VP shunts are excellent when diagnosed and treated early.
Reddy GK, Bollam P, Caldito G. Ventriculoperitoneal shunt surgery and the risk of shunt infection in patients with hydrocephalus: long-term single institution experience. World Neuro-surg. 2012;78:155–63.
Sathyanarayana S, Wylen EL, Baskaya MK, et al: Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases. Surg Neurol 2000; 54:388–96.
Vinchon M, Baroncini M, Laurent T, et al: Bowel perforation caused by peritoneal shunt catheters: diagnosis and treatment. Neurosurgery 2006; 58(suppl 1): ONS76 – 82.
Liu Y, Li C, Tian Y. Ventriculo–peritoneal shunt trans–anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature. Chin Neuro surg J. 2017;3:9.
Park CK, Wang KC, Seo JK, Cho BK: Transoral protrusion of peritoneal catheter: a case report and literature review. Childs Nerv Syst 2000; 16:184-9.
Grewal SS, Jhawar SS, Gupta B, Bedi NK. Silent bowel perforation with per anal protrusion of ventriculoperitoneal shunt. CHRISMED Journal of Health and Research 2014;1:113-5.
Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, Chanchlani R, et al. Trans‑anal protrusion of ventriculo‑peritoneal shunt catheter with silent bowel perforation: Report of ten cases in children. Pediatr Surg Int 2007;23:575-80.
Yilmaz N, Krymaz N, Yilmaz C, Casken H, Yuca SA. Anal protrusion of ventriculoperitoneal shunt catheter: Reports of two infants. J Pediatr Neurol 2004;2:241-4.
Jindal A, Kansal S, Mahapatra AK. Unusual complication – VP shunt coming out per rectum and brain abscess. Indian J Pediatr 1999;66:463-5.
Bodeliwala S, Agrawal A, Mittal A, et al. Transanal protrusion of ventriculoperitoneal shunt via appendicular perforation: A rare case report. J PediatrNeurosci. 2016;11:274–6.
Yousfi MM, Jackson NS, Abbas M, et al. Bowel perforation complicating ventriculoperitoneal shunt: case report and review. Gastrointest Endosc 2003; 58: 144–8.
Robert BS, Michael HL, Richard AR. Colonic perforation by ventriculoperitoneal shunt. Surg Neurol. 1986; 25: 173–7.
Vuyyuru S, Ravuri SR, Tandra VR, Panigrahi MK. Anal extrusion of a ventriculo peritoneal shunt tube: Endoscopic removal. J Pediatr Neurosci. 2009;4:124-6.
Matsuoka H, Takegami T, Maruyama D, Hamasaki T, Kakita K, Mineura K. Transanal prolapse of a ventriculoperitoneal shunt catheter--case report. Neurol Med Chir (Tokyo). 2008;48:526-8.
Handa R, Kale R, Harjai MM. Unusual Complication of Ventriculoperitoneal Shunt: Anal Extrusion. MJAFI 2007;63:82-4.
Prusseit J, Simon M, von der Brelie C, Heep A, Molitor E, Volz S, et al. Pediatr Epidemiology, prevention and management of ventriculoperitoneal shunt infections in children. Neurosurg 2009; 45:325-36.
Karavdic K, Karamustafic A, Herenda N. Laparascopic management of Postventriculoperitoneal Shunt Abdominal Pseudocyst in 10 Years Old Girl. Surgeries 2019; 1(1): 3.
Birbilis T, Zezos P, Liratzopoulos N, Oikonomou A, Karanikas M, Kontogianidis K, et al. Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report. Cases J 2009;7:8251.
Hai A, Rab AZ, Ghani I, Huda MF, Quadir AQ. Perforation into gut by ventriculoperitoneal shunts: a report of two cases and review of the literature. J Indian Assoc Pediatr Surg 2011;16:31e3.
Martinez Hernández-Magro P, Barrera Román C, Villanueva Sáenz E, Zavala MJ: Colonic perforation as a complication of ventriculoperitoneal shunt: a case report. Tech Coloproctol 2006; 10:353- 5.
Popa F, Grigorean VT, Onose G, Popescu M, Strambu V, Sandu AM. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt. J MedLife 2009;2(4):426-36.
Ghritlaharey RK, Budhwani KS, Shrivastava DK, Gupta G, Kushwaha AS, Chanchlani R, Nanda M. Trans-anal protrusion of ventriculoperitoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int 2007;23:575-80.
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