Transoral protrusion of a peritoneal catheter: a case report and literature review

Abstract

Transoral protrusion of a peritoneal catheter is rare. Only two cases have been reported in the English literature. We now report the case of a 5-year-old girl who presented with a catheter that had been inserted 4 years previously, protruding from her mouth. Signs of cerebrospinal fluid infection or peritonitis were absent. The peritoneal catheter was cut and externalized at the chest. The distal portion, which had perforated the stomach wall, was removed using endoscopic procedures. After 3 weeks of antibiotic treatment, a new shunt was inserted. Analysis of 50 cases of bowel perforation extracted from the English literature showed that among the suggested factors such as age, gender, nutritional state, history of abdominal surgery, and length and type of the catheter, age was the only predisposing factor. In the treatment of bowel perforation by a peritoneal catheter, suspected shunt infection should be managed properly and contamination be minimized during removal of the peritoneal catheter.

Ventriculoperitoneal shunt perforations of the gastrointestinal tract

“…7,25,27,32 If a shunt perforates the GI tract, it migrates most often caudally thereafter to protrude through the anal orifice, but has been reported to migrate upward and protrude through the oral cavity. 2,5,6,9,15,21,23,27,29 More than 50% of VP shunt protrusions occur in patients less than 10 years of age. …”

“…2,5,6,9,15,21,23,27,29 More than 50% of VP shunt protrusions occur in patients less than 10 years of age.…”

“…3,4,14,23,26,31 Forceful repeated retching and vomiting may cause a catheter that perforated the GI tract to migrate proximally to the oral cavity.…”

Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: Case report and review of the literature

“…Because the bowel perforation caused by the shunt is usually very small, in most of the cases, it would seals by itself. Thus, laparotomy is rarely necessary and is indicated only for those patients who present with acute abdomen [11,29,30].…”

“…The possible factors responsible for BPPC are thin bowel walls in children, a sharp and stiff end of the V-P shunt [29], the use of a trocar by the operating surgeons [33], chronic irritation from the shunt, previous surgery, infection and silicone allergy [34].…”