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

Liu, Yuhan; Li, Chunde; Tian, Yongji

doi:10.1186/s41016-016-0064-1

Cited by 7 publications

(14 citation statements)

References 31 publications

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“…9,11,12,18,20,25 Few of the cases of VPS catheter extrusion through the anus also presented with the additional features of meningitis/ventriculitis. 26,27 In all the cases, the clinical diagnosis was obvious due to the presence of a distal VPS catheter protruding out through the anal canal. CSF was also draining from the tip of the extruded distal VPS catheter in n=20 children, while in n=5, it was not draining CSF.…”

Section: Discussionmentioning

confidence: 99%

Management of trans-anal extrusion of distal ventriculoperitoneal shunt catheter in children

Ghritlaharey

2022

Int J Res Med Sci

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Background: The objectives of this study were to review the demographics, clinical characteristics, surgical procedures executed, and the outcome of children operated upon for trans-anal extrusion of the distal VPS (ventriculoperitoneal shunt) catheter.Methods: Case records of children under 12-years, operated upon for the trans-anal extrusion of the distal VPS catheter, were reviewed in detail.Results: This study comprised of, n=25 children and included, n=14 boys and, n=11 girls. The interval from the primary VPS insertion/VPS revision to the diagnosis of trans-anal extrusion of the distal VPS catheter ranged from 2 to 49-months, with a mean of 10.04 (11.58 SD/ months. Clinically, all children presented with trans-anal extrusion of the distal VPS catheter. None of them had clinical features of peritonitis, intestinal obstruction, or meningitis. Operative procedures performed in the following order of frequency; (a) removal and immediate revision of the peritoneal/distal VPS catheter n=15 (60%), (b) removal of entire VPS catheter and delayed re-VPS insertion n=4 (16%), (c) removal of peritoneal/distal VPS catheter, external ventricular drainage (EVD) followed by delayed re-VPS insertion n=3 (12%), (d) removal of entire VPS catheter and immediate re-VPS insertion n=1 (4%) and (e) removal of entire VPS catheter alone n=2 (8%). Conclusions: Trans-anal extrusion of the distal VPS catheter is well-known, but rare complication of the VPS insertion done in children. In sixty percent of children, removal and immediate revision of the peritoneal/distal VPS catheters were done safely by mini-laparotomy. During the management, formal abdominal explorations were neither executed nor required in any case.

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Section: Discussionmentioning

confidence: 99%

Management of trans-anal extrusion of distal ventriculoperitoneal shunt catheter in children

Ghritlaharey

2022

Int J Res Med Sci

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“…Most of the cases reported with this complication, suffered this condition in months after surgery and most of them happened in children and were asymptomatic. 8 , 9 , 10 , 11 …”

Section: Discussionmentioning

confidence: 99%

“…It has been recommended that in the acute cases of perforation with gastrointestinal symptoms, or signs of peritonitis, an emergency laparotomy should be done in order to remove the shunt or repair the perforation; in additional, a peritoneal lavage may be indicated. 8 , 9 , 12 Removing the distal end of the shunt, either manually through the anus or during laparotomy, should be done with extreme caution in order to minimize the probable contamination of the peritoneal cavity and CSF. In the previous literature, laparoscopic management of this situation and removal of the shunt have also been suggested.…”

Section: Discussionmentioning

confidence: 99%

A case of transanal protrusion of ventriculoperitoneal shunt in an adult patient without any classic symptoms of bowel perforation

Mirjalali,

Seyedyousefi

2024

Clinical Case Reports

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Key Clinical MessageThis report emphasizes the significance of acknowledging infrequent yet severe complications such as bowel perforation and transanal protrusion post ventriculoperitoneal shunt (VPS) surgery. VPS patients should be observed for atypical indicators and manifestations that could suggest the presence of such complications, even in the lack of traditional clinical signs of peritonitis or bowel perforation.AbstractPlacing an intracranial shunt, may be a reasonable approach to decrease the complications of hydrocephalus and it can be done either simultaneous to cranioplasty or not. Ventriculoperitoneal shunts were first proposed in 1905 and has been used since. Similar to any other procedure, there are different complications to this surgery. Abdominal complications, including peritoneal pseudocysts, intestinal volvulus, protruding in hernial sac or extrusion through vagina, scrotum, umbilicus or gastrointestinal tract, are rare but according to previous studies happen in 5%–47% of cases. Bowel perforation is a rare complication and can happen in 0.01%–0.07% of patients. It's also worth mentioning that only 25% of patients with bowel perforation experience the classic clinical symptoms of peritonitis or bowel perforation. This particular complication should not be overlooked since it can cause a high mortality rate of 15%. Here we present a case of transanal protrusion of ventriculoperitoneal shunt after an asymptomatic bowel perforation, in an adult who has undergone surgery after a traumatic brain injury. The patient has undergone surgery and lastly the shunt was manually removed from anus. He was monitored for 3 days and eventually discharged.

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“…To our best knowledge, a total of 113 cases, including our case, reported anal protrusion of VP shunt with 58 cases ranging from 0-10 years. 2,6 Nevertheless, 47.4% present with the manifestations of acute abdomen, for instance, diarrhea, abdominal pain and tenderness. 7 Patients may reveal symptoms and signs of raised intracranial pressure, meningitis, ventriculitis and cerebral abscess as well.…”

Section: Discussionmentioning

confidence: 99%

“…1 Spontaneous bowel perforation is a rare complication of VP shunt, where it can occur anytime, ranging from few weeks to several years after the insertion of the device in 0.01% to1% of patients. 2 It can present with a wide range of manifestations starting from being asymptomatic in up to 50% of the cases, to the extent of developing serious infectious complications, sepsis or even death. 3 In this study, we report a case of a 2-year-oldgirl with a VP shunt catheter migrating into the colon and protruding through the anus 1 year after its placement.…”

Section: Introductionmentioning

confidence: 99%

Silent colonic perforation complicating a ventriculoperitoneal shunt with trans-anal protrusion

Zain¹

2019

MOJCR

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Ventriculoperitoneal shunt (VPS) is the most common treatment for hydrocephalus, but it can have many complications. Migration of the distal catheter within the bowel is a rare complication, but it can result in a potentially serious infectious complication, sepsis, or even death. In this study, we report a case of a young child with a peritoneal shunt catheter migrating into the colon and protruding through the anus.

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

Cited by 7 publications

References 31 publications

Management of trans-anal extrusion of distal ventriculoperitoneal shunt catheter in children

Management of trans-anal extrusion of distal ventriculoperitoneal shunt catheter in children

A case of transanal protrusion of ventriculoperitoneal shunt in an adult patient without any classic symptoms of bowel perforation

Silent colonic perforation complicating a ventriculoperitoneal shunt with trans-anal protrusion

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