Transanal protrusion of ventriculoperitoneal shunt

Duodenal perforation as a postoperative complication after ventriculoperitoneal shunt: A case report

INTRODUCTION AND IMPORTANCE

Ventriculoperitoneal shunt (VP shunt) is the one of the most common and important tools for the treatment of hydrocephalus. It requires simple technique and demonstrates effectiveness in treating hydrocephalus. However, many complications have been reported such as infection, valve obstruction, valve dysfunction and abdominal complications. Complications of intestinal perforation and catheter penetrating the intestine are very rare, accounting for 0.01-0.07% of abdominal complications. In the literature, 94 cases of intestinal perforation and catheter penetration and only 2 cases of duodenal perforation have been reported.

CASE PRESENTATION

In this study, we report a successful surgical treatment of a duodenal perforation complication after 5 months of VP shunt. Gastroscopy showed the distal tip penetrating into the D2 segment of the duodenum. Surgery was performed to relocate the abdominal tip and to repair the perforation. Meningitis was treated with antibiotics. The patient was stable and discharged after 3 weeks.

CLINICAL DISCUSSION

The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.

CONCLUSION

Intestinal perforation with VP shunt catheter is rare. Diagnosis is simple if the catheter comes out of the anus, mouth, vagina, penis, scrotum, navel. In case when the catheter is inside the lumen of the gastrointestinal tract, diagnosis often requires imaging such as abdominal computed tomography, and gastrointestinal endoscopy. Surgery treatment was to replace the drainage valve and to close the perforation the digestive tract.

Core curriculum illustration: ventriculitis as a complication of ventriculoperitoneal shunt-induced rectal perforation

This is the 35th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.aseronline.org/curriculum/toc.htm.

Silicone spaghetti

Migration of ventriculoperitoneal shunt catheters, although infrequent, is well reported. We report the unusual event of a patient who, after having had three shunt revisions over a 15-year period, presented with a per-oral extrusion of her original distal catheter.