Ventriculoperitoneal shunt perforations of the gastrointestinal tract

Thiong’o, Grace M.; Luzzio, Christopher; Albright, A. Leland

doi:10.3171/2014.11.peds14347

Cited by 28 publications

(19 citation statements)

References 27 publications

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“…Thiongo et al report on a case where the retrograde spread of infection led to an enterocutaneous fistula, wherein the subcutaneous abscess moved upward from the intestine to the chest [13]. Similarly, in our case, the subclavicular abscess was caused by the retrograde spread of infection.…”

Section: Discussionsupporting

confidence: 67%

“…The etiology of BPPC remains unknown in many cases. However, several risk factors have been postulated including the thin bowel wall of children, stiff distal catheters, silicone allergy, or use of abdominal trocars [13]. The mechanisms of BPPC may be categorized into the following two types: an acute-traumatic type occurring during the initial distal catheter placement or a chronic-irritative type [7].…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…9 Other predisposing factors include type of catheter used, one study had observed that catheter with greater friction force tends to be tangled with abdominal tissue or omentum leads to perforation of bowel. 10 The redundant length of VPS within peritoreal cavity might increase friction force with bowel thus leads to migration and perforation.…”

Section: Resultsmentioning

confidence: 99%

Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen

2021

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Introduction: Ventriculoperitoneal shunt (VPS) is most commonly performed surgical treatment for hydrocephalus by draining excessive cerebrospinal fluid (CSF) in ventricles to peritoneal cavity. Despite significant improvement in shunt procedure and being a relatively simple procedure, shunt complications remain common. Aim: The aim of this paper is to report a case of perforated bowel presented with silence abdomen following VPS insertion. Case study: We report a case of protrusion of distal VPS catheter through anus with silent abdomen, managed successfully with minimal intervention. Patient, 11-months-old male infant, diagnosed with congenital communicating hydrocephalus and VPS placement was done at 6 months of life, presented with tip of VPS protruding from anus after 4 months of VPS insertion. Patient was scheduled for removal of VPS, where shunt was disconnected through superficial abdominal incision, distal portion removed through anus without resistance. Postoperative patient recovers well without abdominal complication. Results and discussion: Perforation of bowel by distal peritoneal catheter is rare and only accounts for 0.1%–0.7% of complication. The exact pathogenesis for spontaneous bowel perforation is unclear. Management of bowel perforation secondary to VPS is highly individualized, mainly depending on its clinical symptoms and signs. Conclusions: Although bowel perforation following VPS insertion is rare, it carries high mortality up to 15% especially if unrecognized and delayed in treatment. Early detection and appropriate management are key in reducing VPS related morbidity and mortality.

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“…Death is reported in up to 15% of cases. Nonetheless, signs of peritonitis occur in less than 25% of patients and most of the cases are asymptomatic or exhibit catheter protrusion through the anus or mouth [3,6] . This patient denied abdominal pain and there were no radiological signs of free air in the abdominal cavity.…”

Section: Discussionmentioning

confidence: 99%

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

Alves

Mendes

Lopes

et al. 2017

GE Port J Gastroenterol

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Abordagem endoscópica de perfuração do cólon por cateter de derivação ventrículo-peritoneal: caso clínico e revisão da literatura Palavras Chave Derivação ventrículo-peritoneal · perfuração cólica · colonoscopia ResumoOs autores descrevem o caso de uma mulher de 42 anos com perfuração do cólon por cateter de derivação ventrí-culo-peritoneal (DVP) colocado 28 anos antes. No contexto de meningite aguda a Escherichia coli , o estudo complementar com tomografia computadorizada abdominal identificou a extremidade distal do cateter de DVP no interior do lúmen do cólon esquerdo. Após remoção da extremidade ventricular do cateter, optou-se pela tentativa de extração da extremidade intra-cólica por colonoscopia. Durante a extração do cateter com ansa de polipectomia, constatou-se secção do mesmo no local de entrada na parede cólica, observando-se um pequeno orifício. Keywords Ventriculoperitoneal shunt · Intestinal perforation · Colonoscopy AbstractThe authors report the case of a 41-year-old woman with a colonic perforation due to a ventriculoperitoneal shunt (VPS) catheter. Left-sided colonic perforation was diagnosed by abdominal computed tomography 28 years after shunt placement, following acute meningitis caused by Escherichia coli . The proximal end of the VPS was exteriorized and it was decided to remove the distal end by colonoscopy. After pulling out the catheter with a polypectomy snare, it broke at the site where it was entering the colon, leaving a small perforation in the colonic wall which was closed with 2 endoclips. The endoluminal fragment of the catheter, being 20 cm in length, was removed through the rectum. The patient is asymptomatic at the 12-month follow-up. A review of the literature regarding 9 endoscopically managed cases of digestive tract perforation caused by VPS is presented. Procedeu-se ao encerramento da perfuração com 2 endoclips e extração do fragmento livre endoluminal do cateter, com cerca de 20 cm, pelo reto. A doente permanece assintomática após 12 meses de seguimento. Uma revisão da literatura identificou 9 casos de perfuração do tubo digestivo por cateter de DVP tratados com endoscopia.

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Ventriculoperitoneal shunt perforations of the gastrointestinal tract

Cited by 28 publications

References 27 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

Protrusion of ventriculoperitoneal shunt catheter tip through anus with silence abdomen

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

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