Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children

Abstract

Ventriculo-peritoneal (VP) shunting used in the treatment for hydrocephalus is associated with several complications. Mechanical failure of shunt is the commonest complication of all. Visceral/bowel perforation is an unusual but serious complication of VP shunting. This article reports our experience in the management of ten children who had VP Shunt catheter protrusion from anus. This is a retrospective study of ten patients who had VP shunt catheter protrusion from anus, admitted in the department of paediatric surgery between Jan 1996 and Dec 2005. The records of above ten cases were reviewed for their clinical presentation and management, etc. We had performed 398 VP shunt operations in the last 10 years. Two hundred and seventy one (68.09%) VP Shunts were done for congenital hydrocephalus of which 164 were done in infancy/neonatal period and 107 VP shunts were done in the age group of >1-12 years. One hundred and twenty-seven (31.90%) VP shunt operations were done for patients who had hydrocephalus as a complication following tubercular meningitis (TBM). Out of 398 VP shunts, ten patients (2.51%) had protrusion of the distal end of peritoneal catheter from anus without causing/leading to peritonitis. We observed a 08.29% mortality of all VP shunt operations. Protrusion of VP shunt catheter per rectum can occur without producing peritonitis. Formal exploration and localization of entry of VP shunt catheter in bowel is not mandatory. Mini laparotomy and revision of peritoneal part of shunt can be done if there is no shunt infection.

Ventricular migration of shunt: Chhabra shunt complication

“…[1][2][3]10,11,13,16,17,19,22 Almost all have reported such cases in malnourished infants with complicated postoperative course. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Heim and Kim have reported migration of ventriculoperitoneal shunt to subgaleal and subdural spaces. 4,5 The probable cause of retrograde migration is a much debated subject with numerous hypothesis forwarded in literature.…”

“…An increasing number of reported cases are from Indian subcontinent and mostly the Chhabra shunt is implicated in this complication. [1][2][3]10,11,13,16,17,19,21,22 The cylindrical soft chamber and the practice of repeated pressing of chamber to flush the chamber may be one of the important causes along with the above ones in pushing the shunt retrogradely into ventricles. A case of intracranial migration has known to cause visual disturbances; maybe due to pressure on optic pathways and raised intracranial pressure.…”

“…It's a notorious procedure with many complications ranging from blockage, infection, migration to peritoneal cavity, bladder, pleural cavity. [1][2][3][4] We are reporting the rarest complication in which there was complete migration of whole shunt into the ventricles and discuss the reported cases and try to form a hypothesis about the causes of this complication.…”

Untitled

“…These reports involve intestinal volvulus, pseudocyst, and catheter extrusion through the scrotum, umbilicus, vagina, or gastrointestinal tract [4]. The distal component among the valve and the peritoneal catheter is the most probable site of disconnection [5]. Cervical motion and growth might characterize the chief factors leading to shunt system discontinuity [6].…”

“…Cervical motion and growth might characterize the chief factors leading to shunt system discontinuity [6]. It has been emphasized that usage of the leotard shunt system may offer the most promising method of avoiding shunt disconnection and its potential complications [5].…”