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Surg Neurol Int. 2016 Dec 28;7(Suppl 44):S1150-S1153. doi: 10.4103/2152-7806.196930. eCollection 2016.

Transanal presentation of a distal ventriculoperitoneal shunt catheter: Management of bowel perforation without laparotomy.

Author information

1
Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
2
Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.

Abstract

BACKGROUND:

Bowel perforation is a serious but rare complication after a ventriculoperitoneal shunt (VPS) procedure. Prior studies have reported spontaneous bowel perforation after VPS placement in adults of up to 0.07%. Transanal catheter protrusion is a potential presentation of VPS bowel perforation and places a patient at risk for both peritonitis and ventriculitis/meningitis via retrograde migration of bacteria. This delayed complication can be fatal if unrecognized, with a 15% risk of mortality secondary to ventriculitis, peritonitis, or sepsis.

CASE DESCRIPTION:

We describe a unique case of a patient with distal VPS catheter protrusion from the anus whose bowel perforation did not cause clinical sequelae of infection. We were able to manage the patient without laparotomy.

CONCLUSIONS:

A subset of patients can be managed without laparotomy and only with externalization of the ventricular shunt with antibiotics until the cerebrospinal fluid cultures finalize without growth.

KEYWORDS:

Bowel perforation; complications; ventriculoperitoneal shunt

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