Bowel perforation presenting with acute abdominal pain and subcutaneous emphysema in a 14-year-old girl with an abandoned distal peritoneal shunt catheter: case report

Abstract

<jats:p>The authors report the case of 14-year-old girl with a history of myelomeningocele and previously shunt-treated hydrocephalus who presented with right-sided abdominal pain and subcutaneous emphysema that developed over a 1-week period. A CT scan of the patient's abdomen revealed a retained distal ventriculoperitoneal (VP) catheter with air tracking from the catheter to the upper chest wall. Given the high suspicion of the catheter being intraluminal, an exploratory laparotomy was performed and revealed multiple jejunal perforations. The patient required a partial small-bowel resection and reanastomosis for complete removal of the retained catheter. Six other similar cases of bowel perforation occurring in patients with abandoned VP and subdural-peritoneal shunts have been reported. The authors analyzed these cases with regard to age of presentation, symptomatic presentation, management, morbidity, and mortality. While there was 0% mortality associated with bowel perforation secondary to a retained distal VP catheter, the morbidity was significantly high and included peritonitis and small bowel resection.</jats:p>

Bowel perforation after ventriculoperitoneal-shunt placement: case report and review of the literature

“…In this paper, we present a rare case of BPPC in a patient with an abandoned peritoneal catheter 28 years after initial VP shunt placement. In light of the overall high mortality and morbidity rates [5][6][7], BPPC can be regarded as a significant long-term complication. The overall incidence of BPPC in the long-term follow-up of our patient cohort is 1.8% (2 out of 112 patients).…”

“…However, several risk factors have been postulated including the thin bowel wall of children, stiff distal catheters, silicone allergy, or use of abdominal trocars [13]. The mechanisms of BPPC may be categorized into the following two types: an acute-traumatic type occurring during the initial distal catheter placement or a chronic-irritative type [7]. The chronic-irritative type may be the main reason for late cases of BPPC and is caused by a break in the continuity of the epithelium around the contact site of the distal catheter leading to local inflammation, fibrosis, and adherence of the catheter to the bowel wall.…”

“…During revision, total shunt removal may be difficult in some cases. Metal connectors placed after piecemeal shunt revision can lead to increased difficulty with removal [7]. Furthermore, it has been demonstrated that shunt catheters become degraded during long-term implantation leading to calcifications or are encased in a fibrous reaction zone called a fibrous tunnel [8].…”

“…Only a very few cases of intraabdominal complications from abandoned distal catheters have been reported so far [7]. However, due to the reported significant morbidity and mortality rates after BPPC [5,6], strategies to avoid abdominal complications especially in long-term survivors are highly desired.…”

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

“…Despite its current popularity, VPS is still associated with multiple complications, which arise more frequently at the distal than the proximal end (Kast et al, ). A constellation of complications pertaining to the distal end of the VPS has been reported, including shunt infection (Kanev and Sheehan, ), with (Knuth et al, ) or without (Nakahara et al, ) retrograde meningitis; shunt obstruction (Browd et al, ); distal catheter migration (Abode‐Iyamah et al, ); re‐coiling (Cho et al, ); segmental breakage or disconnection (Riccardello et al, ); ascites (DiLuna et al, ); CSF pseudocyst formation (Tamura et al, ); pleural effusion (Ergün et al, ); intra‐abdominal seeding of infection (Laucks et al, ); allergy (AbdelAziz et al, ); conveyance of the malignant metastatic cells of an intra‐cranial tumor to the abdominal cavity (Donovan and Prauner, ); and even death (Ghritlaharey et al, ). Among these, distal catheter migration is considered a common complication entailing both clinical and anatomical concerns (Popa et al, ; Ghritlaharey et al, ; Dakurah et al, ).…”