Kornaropoulos M, Makris M, Modestou E, Karatzias V, Krikelis A, Thanopoulos A, Liapi A, Mitrousias A, Katsogiannos D, Kokkalas G, Zevlas A, Gettimis E. Bowel perforation by lumbar-peritoneal (LP) shunt: A rare complication of neurosurgery.
Int J Surg Case Rep 2018;
44:217-219. [PMID:
29529543 PMCID:
PMC5927809 DOI:
10.1016/j.ijscr.2018.02.031]
[Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/13/2018] [Accepted: 02/17/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION
Lumbar-peritoneal (LP) and ventriculo-peritoneal (VP) shunt placement is the treatment of choice for diversion of cerebrospinal fluid (CSF) from the subarachnoid space into the peritoneal cavity. This invasive procedure has been associated with several complications, most commonly infection and obstruction. Perforation of the bowel is an extremely rare complication.
CASE PRESENTATION
We report a case of a 72 old female patient with LP shunt for raised intracranial pressure, who presented with LP shunt catheter protruding from anus. This was due to bowel perforation in the recto-sigmoid junction by the distal tip of lumbar-peritoneal shunt. She was surgically treated with removal of the distal part of the shunt, external drainage of the proximal part and primary closure of the perforation.
DISCUSSION
The mortality after perforation is relatively high, approaching 15-18%, and it is further increased when infection is present up to 22% with central nervous system (CNS) infection such as meningitis, encephalitis, or brain abscesses (Vinchon, 2006) and 33% with intra-abdominal infection.
CONCLUSION
Clinical suspicion of abdominal complications by the LP should be raised when patient with hydrocephalus develops acute abdominal symptoms or infection with unusual positive CSF cultures.
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