Rare Complication of Ventriculoperitoneal Shunt: Anal Extrusion

Title: Rare Complication of Ventriculoperitoneal Shunt: Anal Extrusion

Authors: Dr Pravin Bhingare, Dr Ninad Sawant

DOI: https://dx.doi.org/10.18535/jmscr/v4i12.53

Abstract

Ventriculoperitoneal Shunt (VP shunt) surgery is one of the common neurosurgical procedure employed in management of hydrocephalus. Most common complications of VP shunt surgery include shunt malfunction secondary to partial or complete blockage, Shunt infections, slit ventricle syndrome due to over drainage of cerebrospinal fluid and multiloculated hydrocephalus. On distal end abdominal complications like peritoneal pseudocysts, lost distal catheters, bowel perforations and hernias may be seen. Anal extrusion of peritoneal end of VP shunt by perforating intestines requiring revision of shunt is a very rare complication of VP shunt surgery. We report here a case of 7 months old male child who underwent VP shunt surgery at the age of 1 month for congenital hydrocephalus. The baby underwent a revision surgery for blockage of VP shunt 5 months after the first surgery. Now the baby presented with extrusion of peritoneal end of VP shunt through anus. There was evidence of CSF draining through the extruded end of VP shunt. A revision surgery on other side was done. After surgery the baby gradually improved and was eventually discharged after 3 weeks.

Keywords- Congenital Hydrocephalus, Ventriculoperitoneal shunt, Anal Extrusion.

References

1. Kahle KT, Kulkarni AV, Limbrick DD Jr, Warf BC. Hydrocephalus in children Lancet. 2016 Feb 20;387(10020):788-99.

2. Kartal MG, Algin O. Evaluation of hydrocephalus and other cerebrospinal fluid disorders with MRI: An update. Insights into Imaging. 2014;5(4):531-541.

3. Rizvi R, Anjum Q. Hydrocephalus in children. J Pak Med Assoc. 2005 Nov;55(11):502-7.

4. Venkataramana NK. Hydrocephalus Indian scenario – A review. Journal of Pediatric Neurosciences. 2011;6(Suppl1):S11-S22.

5. Notarianni C, Vannemreddy P, Caldito G, Bollam P, Wylen E, Willis B, Nanda A. Congenital hydrocephalus and ventriculoperitoneal shunts: influence of etiologyand programmable shunts on revisions. J Neurosurg Pediatr. 2009 Dec;4(6):547-52.

6. Ames RH. Ventriculo-peritoneal shunt: The management of hydrocephalus. J Neurosurg. 1967;27:525–529.

7. Berner R, Heinen F, Pelz K, van Velthoven V, Sauer M, Korinthenberg R. Ventricular shunt infection and meningitis due to Bacillus cereus. Neuropediatrics. 1997 Dec;28(6):333-4.

8. Agha FP, Amendola MA, Shirazi KK, Amendola BE, Chandler WF Abdominal complications of ventriculoperitoneal shunts with emphasis on the role of imaging methods. Surg Gynecol Obstet. 1983 Apr; 156(4):473-8.

9. Vuyyuru S, Ravuri SR, Tandra VR, Panigrahi MK. Anal extrusion of a ventriculo peritoneal shunt tube: Endoscopic removal. Journal of Pediatric Neurosciences. 2009;4(2):124-126.

10. Li XY, Wang ZC, Li YP, Ma ZY, Yang J, Cao EC. [Study on treatment strategy for ventriculitis associated with ventriculoperitoneal shunt for hydrocephalus].2005 Sep;17(9):558-60.

11. Bateman GA, Smith RL, Siddique SH. Idiopathic hydrocephalus in children and idiopathic intracranial hypertension in adults: two manifestations of the same pathophysiological process? J Neurosurg. 2007 Dec;107(6 Suppl):439-44.

12. Ghritlaharey RK, Budhwani KS, Shrivastava DK, Srivastava J. Ventriculoperitoneal shunt complications needing shunt revision in children: a review of 5 years of experience with 48 revisions. Afr J Paediatr Surg. 2012 Jan-Apr;9(1):32-9.

13. Panagea S, Cartmill TD, Panigrahi H. Intracerebral sepsis due to intestinal perforation by ventriculo-peritoneal shunts: two cases. J Infect. 1997 Jul;35(1):86-8.

14. Wilson CB, Bertan V. Perforation of the bowel complicating peritoneal shunt for hydrocephalus. Report of two cases. Am Surg. 1966 Sep;32(9):601-3.

15. Schulhof LA, Worth RM, Kalsbeck JE. Bowel perforation due to peritoneal shunt. A report of seven cases and a review of the literature. Surg Neurol. 1975 May; 3(5):265-9.

16. VandeVord PJ, Gupta N, Wilson RB, Vinuya RZ, Schaefer CJ, Canady AI, Wooley PH. Immune reactions associated with silicone-based ventriculo-peritoneal shunt malfunctions in children. Biomaterials. 2004 Aug;25(17):3853-60.

17. Hai A, Rab AZ, Ghani I, Huda MF, Quadir AQ. Perforation into gut by ventriculoperitoneal shunts: A report of two cases and review of the literature. Journal of Indian Association of Pediatric Surgeons. 2011;16(1):31-33.

18. Rinker EK, Osborn DA, Williams TR, Spizarny DL. Asymptomatic Bowel Perforation by Abandoned Ventriculoperitoneal Shunt. Journal of Radiology Case Reports. 2013;7(9):1-8.

19. Birbilis T, Zezos P, Liratzopoulos N, et al. Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report. Cases Journal. 2009;2:8251.

20. Bourm K, Pfeifer C, Zarchan A. Small bowel perforation: a rare complication ventriculoperitoneal shunt placement. J Radiol Case Rep. 2016 Jun 30;10(6):30-35.

Corresponding Author

Dr Ninad Sawant

Resident, Department of Surgery

Government Medical College, Nagpur India