Endoscopic Management of Colonic Perforation due to Ventriculoperitoneal Shunt: Case Report and Literature Review

Alves, Ana Rita; Mendes, Sofia; Lopes, Sandra; Monteiro, Alexandre; Perdigoto, David N; Amaro, Pedro; Tomé, Luís

doi:10.1159/000454987

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…Alves et al reported a case of symptomatic colonic perforation 28 years after the initial shunt placement presenting with acute meningitis. In this case, during endoscopic exploration, chronic fibrous tissue around the site where the catheter had entered the colon was observed; therefore, the spillage of bowel contents into the peritoneal cavity was prevented [14]. These papers indicate that patients with intracerebral sepsis due to enteric bacteria must be assessed for BPPC [6,15].…”

Section: Discussionmentioning

confidence: 85%

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

et al. 2020

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AbstractBowel perforation by a peritoneal catheter (BPPC) is a serious complication after ventriculoperitoneal shunting, with high mortality and morbidity rates. This patient presented with scalp ulceration over the shunt valve at the retromastoid region 26 years after shunt placement. During revision, the catheter distal to the valve was divided in the clavicular region. As there was no cerebrospinal fluid drainage, we decided to remove the ventricular catheter and valve. The ulceration was debrided and primarily closed. Distal to the clavicle, the disconnected peritoneal catheter was encased in a fibrous, calcified tunnel. To avoid piecemeal resection with multiple incisions, the catheter was not retrieved. Two years later, the patient presented with an abscess and pus draining from the clavicular wound. Cultures were positive for enteric bacteria. BPPC with retrograde spread of infection was suspected, and abdominal computed tomography confirmed perforation. We removed the disconnected catheter, but the perforation site could not be detected during laparotomy. The patient was treated with intravenous antibiotics and recovered without complications. To minimize complications, abandoned catheters should be avoided. Otherwise, patients unnecessarily have a life-long risk of developing abdominal complications. In patients with abandoned catheters and severe abdominal symptoms, BPPC is an important differential diagnosis.

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Section: Discussionmentioning

confidence: 85%

“…In no patient, BPPC occurred >8 years after shunt placement [6]. However, symptomatic BPPC > 20 years after initial shunt placement is extremely rarely reported [14].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Several contributing factors that affect the complications in anal extrusion of peritoneal catheter are thin bowel wall in children (11), sharp and stiff end of VP shunt (5), distal tip of ventricular-peritoneal catheter placement with trocar (10), long peritoneal catheters chronic irritation caused by shunt (12) previous surgery, infection, and silicone allergy (13). Children of families with low socioeconomic status and suffering from malnutrition also have an increased risk of an anal extrusion VP shunt (10).…”

Section: Discussionmentioning

confidence: 99%

Anal Extrusion of Ventriculoperitoneal Shunt: A Case Report and Review of Literature

Bal’afif

Wardhana

Nazwar

et al. 2021

JKB

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<p>Ventriculoperitoneal (VP) Shunt is a commonly performed surgical procedure and offers a good result in the treatment of hydrocephalus. In general, 25% of the complication rate of this surgical procedure is abdominal complications. Anal extrusion of a peritoneal catheter is a rare complication ranging from 0.1 to 0.7% of all shunt surgeries. This study presents a rare case of anal extrusion of ventriculoperitoneal shunt in a 1-year-old female child who was asymptomatic. The physical examination revealed swelling and redness along the shunt tract on the retro auricular region, soft abdomen, and no catheter was observed in the anal. This study found several contributing factors affecting the complications in the anal extrusion of a peritoneal catheter, that are thin bowel wall in children and sharp tip and stiff end of VP shunt. The shunt should be disconnected from the abdominal wall, and the lower end should be removed through the rectum by colonoscopy or sigmoidoscopy/proctoscopy or by applying gentle traction on the protruding tube. This study concludes that due to potentially life-threatening consequences and case rarity, thorough anamnesis, physical examination, and objective investigation are needed to determine the appropriate management for anal extrusion of ventriculoperitoneal shunt. </p>

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“…It is associated with a variety of complications, which occur in an average of 23.8% of cases. A very small portion of these complications is distal shunt migration with gastrointestinal perforation [1,2].…”

Section: Introductionmentioning

confidence: 99%

Ventriculoperitoneal Shunt Device Migration: A Case Report of a Rare Cause of Abdominal Pain

Stephens¹,

Neppl²

2020

Clin Case Rep

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Introduction: Ventriculoperitoneal (VP) placement is the most common procedure performed by neurosurgeons with a high range of reported complication rates with a mean complication rate of 23.8%. Such complications included shunt failure, infection, shunt migration, pneumocephalus, and subdural hematoma. A small portion of the catheter migrations can lead to abdominal pain by penetrating walls of the viscera or the peritoneal wall. Because 15% of these cases result in death, recognizing and treating this complication quickly is essential. Case presentation: A 56-year-old Caucasian male with a history of hydrocephalus treated with multiple VP shunt placements presented to the ED in a community setting three times over the course of two months with RLQ pain. Clinical course: The patient continued to have severe abdominal pain despite multiple visits to the ED and an inpatient stay for treatment of suspected colitis. Referral to general surgery allowed for definitive diagnosis where a diagnostic colonoscopy showed the distal portion of a VP shunt was penetrating the wall of the cecum. Subsequent laparoscopy was performed to remove multiple disconnected VP shunts with closure of the cecotomy with two endoclips, which resulted in rapid improvement of the patient's pain. Conclusion: When considering the differential diagnosis for abdominal pain in a patient with a VP shunt, it is necessary to recognize distal shunt migration as an uncommon but serious cause of the pain. Bowel perforation is a complication of VP shunt placement that occurs in 0.1-0.7% of patients, with 15% of these resulting in death.

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Endoscopic Management of Colonic Perforation due to Ventriculoperitoneal Shunt: Case Report and Literature Review

Cited by 5 publications

References 13 publications

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

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

Anal Extrusion of Ventriculoperitoneal Shunt: A Case Report and Review of Literature

Ventriculoperitoneal Shunt Device Migration: A Case Report of a Rare Cause of Abdominal Pain

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