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

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

Surg Neurol Int. 2016;7(Suppl 44):S1150-S1153

Authors: Bales J, Morton RP, Airhart N, Flum D, Avellino AM

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.

PMID: 28194303 [PubMed - in process]

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