Transanal Prolapse of a Ventriculoperitoneal Shunt Catheter -Case Report-

Abstract

A 4-year-old girl presented with asymptomatic bowel perforation and transanal protrusion of a ventriculoperitoneal (VP) shunt catheter. She had undergone repair of myelomeningocele at birth and subsequent VP shunting for congenital hydrocephalus 1 month later. Seven months after VP shunting, she underwent revision of the peritoneal catheter. She complained of abdominal pain and nausea at the age of 4 years. She was treated conservatively for 1 month for intestinal obstruction. One month later, her mother noticed the shunt catheter protruding from her anus. Computed tomography (CT) of the abdomen revealed that the peritoneal catheter had migrated into the colon, and CT of the head showed symmetrical dilation of the ventricles. The shunt system was removed immediately, repair of the fistula in the sigmoid colon was performed, and external ventricular drainage was continued for 6 weeks until shunt replacement. One month after the first operation, intestinal obstruction recurred. Duplication of the terminal ileum was removed to prevent further recurrence of the intestinal obstruction. She underwent ventriculoatrial shunting 2 weeks after the second operation and was discharged without neurological sequelae.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

“…The mechanism of distal catheter penetration is not exactly understood. However, hypothesized causes include the single or combined effects of pressure erosion after fibrous adhesion, water hammer pressure by CSF pulsation, and direct penetration by the sharp, rigid catheter tip (Oshio et al, 1991;Masuoka et al, 2005;Handa et al, 2007;Matsuoka et al, 2008;Yang and Sim, 2013). Fibrous adhesion entails the formation of a 2) External genitalia 47 (70.1) "" 2 (9.1) <0.01 Umbilicus 4 (6.0) 12 (54.5) "" Scar region 4 (6.0) 8 (36.4) "" Augmented breast 12 (17.9) " 0 (0.0)…”

Transanal protrusion of ventriculoperitoneal shunt reflecting asymptomatic perforation of the large bowel

“…The optimal approach to repair the perforation is unclear, and needs to be tailored to the patient. Laparotomy with or without shunt removal has been successful 11. However, percutaneous12 and endoscopic13 approaches have also been used in patients with no signs of peritonism, and laparoscopic procedures can be employed in cases where the shunt can be removed 14…”

Erosive Bladder Perforation as a Complication of Ventriculoperitoneal Shunt with Extrusion from the Urethral Meatus: Case Report and Literature Review

“…Treatment of these 2 patients was described as suprapubic cystostomy, catheter removal, bladder repair, and antibiotic therapy [1]. There have also been reports of migration of the distal end of the VP shunt into the stomach [2,3], liver [4], pulmonary artery [5,6,7,8], inferior vena cava [9], heart [5,7,8,10,11,12,13], bowel with or without catheter protrusion from the anus [1,14,15,16,17,18,19,20,21,22,23,24,25,26], scrotum [27], vagina [28], and transoral protrusion [29,30,31]. …”

“…There have been numerous theories proposed regarding the mechanism of distal VP shunt perforation into adjacent structures, such as bowel. Formation of fibrous encasement around the peritoneal end of the tube may have an anchoring effect with repeated pressure and mechanical irritation on the adjacent structure, which may eventually lead to perforation [19,21]. Despite initial reports that seemed to demonstrate a higher tendency of perforation with spring-coiled catheters, multiple peritoneal catheter types have been associated with perforation [20,21,22,29,31].…”