Asymptomatic perforated viscus and gram-negative ventriculitis as a complication of valve-regulated ventriculoperitoneal shunts

Rubin, Ronald P.; Ghatak, Nitya R.; Visudhipan, Pongsakdi

doi:10.3171/jns.1972.37.5.0616

Cited by 74 publications

(21 citation statements)

References 11 publications

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“…In addition to other abdominal complications of VP surgery (peritoneal pseudocyst and intestinal volvulus [6,7,8]), extrusion of the catheter is a frightening event for the patient and/or his entourage (scrotum [9], vagina [10], gastrointestinal tract or umbilicus [11,12,13]). In the absence of extrusion of the catheter, the diagnosis of BP can be difficult and delayed because of nonspecific signs particularly in young patients.…”

Section: Discussionmentioning

confidence: 99%

Transoral Protrusion of a Peritoneal Catheter: A Rare Complication of Ventriculoperitoneal Shunt

et al. 2008

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Ventriculoperitoneal (VP) shunt surgery is the most used technique for the treatment of hydrocephalus. This procedure is associated with a large amount of complications. Bowel perforation caused by a peritoneal shunt catheter is one of these complications, sometimes fatal, and is usually difficult to recognize, except when protrusion of the peritoneal catheter through a natural orifice occurs. This report presents the case of a 2-year-old boy who had undergone a VP shunt and later presented with protrusion of the peritoneal catheter through his mouth. The shunt device was removed and an external shunt procedure was achieved, using the original ventricular catheter kept in place. The diagnosis of bacterial meningitis was retained and an antibiotic therapy was started. The evolution was fatal in 15 days secondary to a bacterial ventriculitis. Through the reported cases of bowel perforation, many risk factors were individualized, such as age, congenital etiology of the hydrocephalus, silicon allergy or the length of the peritoneal catheter. Bowel perforation is a serious complication of VP shunt surgery, leading sometimes to a fatal outcome.

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Section: Discussionmentioning

confidence: 99%

Transoral Protrusion of a Peritoneal Catheter: A Rare Complication of Ventriculoperitoneal Shunt

et al. 2008

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“…CT imaging of her head was unchanged from her previous studies. The shunt was immediately externalized at the clavicle and cerebrospinal fluid was evaluated showing: one erythrocyte and no leukocytes per mm 3 , glucose of 104 mg/dL, and protein of 10 mg/dL. The patient immediately underwent ultrasound guided percutaneous drainage of the abdominal collection that revealed pus.…”

Section: Case Reportmentioning

confidence: 99%

“…Alternatively, shunt infection can occur due to direct contamination of the peritoneal end of the shunt by gut flora in the setting of bowel perforation or peritonitis. 3 We present a rare case of a hydrocephalic patient with a ventriculoperitoneal shunt who developed a Streptococcus pyogenes (Group A Streptococcus, GAS) peritoneal catheterassociated intra-abdominal abscess that occurred several weeks after pharyngitis and scarlet fever. GAS colonizes epithelial surfaces, primarily the throat and skin, but also the vagina and rectum, from where it can cause a wide array of superficial, invasive, and immune-mediated diseases.…”

Section: Introductionmentioning

confidence: 99%

Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes after Pharyngitis with Scarlet Fever: Case Report and Review of the Literature

Chen

Monaco²

2014

Neuro Open J

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CitationChen SH, Monaco EA 3 rd . Intra-abdominal ventriculoperitoneal shunt abscess from Streptococcus pyogenes after pharyngitis with scarlet fever: Case report and review of the literature. Neuro Open J. 2014; 1(1): 27-30. doi: 10.17140/NOJ-1-107rd . This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. However, Streptococcus pyogenes (Group A Streptococcus, GAS) as a causative agent appears to be extremely rare. We present an unusual case of a peritoneal shunt infection due to GAS that occurred after pharyngitis with scarlet fever. Case Description: A 31 year-old woman with congenital shunt-dependent hydrocephalus presented with fever, vomiting, and acute abdominal symptoms several weeks after being treated for pharyngitis and scarlet fever. She was found to have a large intra-abdominal peritoneal catheter-associated abscess that grew out GAS. Results: The patient's shunt was externalized at the clavicle and the cerebrospinal fluid (CSF) was sterile. Her peritoneal abscess was treated by percutaneous drainage, laparotomy, and intravenous antibiotics. More permanent CSF diversion was accomplished via ventriculoatrial shunt creation after treatment. She made a full recovery. Conclusion: While shunt infection is an all too common clinical problem, this is the first report of a peritoneal shunt infection caused by GAS after pharyngitis and scarlet fever. Presumably, this infection occurred as a result of haematogenous spread to the shunt site in the abdomen.

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“…7) The initial symptoms of catheter perforation of the bowel include shunt infection, prolonged unexplained diarrhea with sterile cultures, 1) peritonitis, increased intracranial pressure due to shunt failure, 6) extrusion of the peritoneal shunt catheter from the body, 2,8) and pneumocephalus caused by retrograde colonic gas flow through the shunt catheter. 3,9,11) The incidence of peritonitis due to VP shunt perforation is less than 25%. 11) However, colonic perforation does not result in peritonitis if fibrous tracts formed around the shunt catheter block spillage of the bowel contents into the peritoneum.…”

Section: Introductionmentioning

confidence: 99%

“…11) However, colonic perforation does not result in peritonitis if fibrous tracts formed around the shunt catheter block spillage of the bowel contents into the peritoneum. 1,9) We treated a patient with perforation of the bowel manifesting as subcutaneous pneumocele around the VP shunt catheter from the abdomen to the neck.…”

Section: Introductionmentioning

confidence: 99%

Subcutaneous Pneumocele Associated With Ventriculoperitoneal Shunt Migration Into the Mechanically Occluded Colon-Case Report-

Nakahara

Yamada²,

Shimizu³

et al. 2006

Neurol. Med. Chir.(Tokyo)

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A 62-year-old man presented with shunt failure manifesting as consciousness disturbance 4 years after placement of a ventriculoperitoneal shunt for subarachnoid hemorrhage. Physical examination found subcutaneous pneumocele around the peritoneal catheter extending from the abdomen to the neck. He had undergone pelvic radiation therapy for bladder cancer 2 years before. The peritoneal catheter was removed from the cervical region, and external ventricular drainage and a descending colon stoma for ileus release were positioned. The cerebrospinal fluid was clear and yielded no cultures. No inflammatory changes were seen. He developed carcinomatous peritonitis and died 4 months later. Retrograde colon gas reflux due to catheter perforation into the colon occluded by metastatic sigmoid cancer was probably the cause. Fragility of the wall of colon associated with the prior abdominal radiation therapy might have been a contributing factor. Subcutaneous pneumocele around the peritoneal catheter, i.e. pneumocele within the fibrous sheath surrounding the catheter, is a differential diagnosis to cerebrospinal fluid collection in patients with subcutaneous swelling around the catheter.

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Asymptomatic perforated viscus and gram-negative ventriculitis as a complication of valve-regulated ventriculoperitoneal shunts

Cited by 74 publications

References 11 publications

Transoral Protrusion of a Peritoneal Catheter: A Rare Complication of Ventriculoperitoneal Shunt

Transoral Protrusion of a Peritoneal Catheter: A Rare Complication of Ventriculoperitoneal Shunt

Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes after Pharyngitis with Scarlet Fever: Case Report and Review of the Literature

Subcutaneous Pneumocele Associated With Ventriculoperitoneal Shunt Migration Into the Mechanically Occluded Colon-Case Report-

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