Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(04): e382-e385
DOI: 10.1055/s-0042-1748848
Case Report

Spontaneous Anal Extrusion of Ventriculoperitoneal Shunt Catheter: Case Report

Extrusão anal espontânea de catéter de derivação ventriculoperitoneal: Relato de caso
Lívio Pereira de Macêdo 
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Arlindo Ugulino Netto
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Kauê Franke
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Pierre Vansant Oliveira Eugenio
2   Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
,
Lucas Ribeiro de Moraes Freitas
2   Centro de Ciências Médicas, Universidade Federal da Paraíba, João Pessoa, Paraíba, Brazil
,
Victor Ribeiro Xavier Costa
3   Faculdade de Ciências Médicas da Paraíba, João Pessoa, Paraíba, Brazil
,
Eduardo Vieira de Carvalho Júnior
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Igor Vilela Faquini 
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Nivaldo S. Almeida
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
,
Hildo Rocha Cirne Azevedo-Filho 
1   Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
› Author Affiliations Funding The authors declare that they have received no financial support for the research, authorship, and/or publication of the present article.
› Further Information
   Permissions and Reprints

Abstract

Background Ventriculoperitoneal shunt (VPS) has become the standard treatment for congenital hydrocephalus. In the neurosurgical practice, it is a common procedure which usually results in low rates of complication. However, some serious complications can occur, including infections, intestinal perforation, and even death.

Case Description A 19-year-old, female, asymptomatic patient, with a history of appendectomy and revision of the VPS 6 years before, presented spontaneous transanal extrusion of the catheter. Abdominal radiographs and tomography scans showed perforation of the descending colon without peritonitis, with expulsion of the distal tip of the catheter through the anus. The patient underwent removal of the proximal part of the VPS and installation of an external ventricular drain (EVD). On the second postoperative day, there was spontaneous elimination of the distal portion of the catheter, dispensing any additional surgical procedures. With antimicrobial prophylaxis and the contralateral VPS performed, the patient evolved without further complications until discharge. Diverging from cases reported in the literature, the patient in question did not present any abdominal manifestations.

Conclusion Intestinal perforation by VPS may be asymptomatic until anal extrusion occurs. However, the early approach should avoid infections, which are associated with increased mortality. Removing only the proximal catheter, together with antimicrobial prophylaxis, can be an effective, safe and less invasive alternative to manage this complication of VPS.

Keywords

ventriculoperitoneal shunt - intestinal perforation - hydrocephalus


Publication History

Received: 08 January 2022

Accepted: 06 April 2022

Article published online:
16 December 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Agha FP, Amendola MA, Shirazi KK, Amendola BE, Chandler WF. Unusual abdominal complications of ventriculo-peritoneal shunts. Radiology 1983; 146 (02) 323-326 DOI: 10.1148/radiology.146.2.684907.
    CrossrefPubMedGoogle Scholar
  • 2 Hasan A, Sharma S, Chopra S, Purohit DK. Anal Extrusion of Ventriculoperitoneal Shunt: A Report of Two Cases and Review of Literature. J Pediatr Neurosci 2018; 13 (01) 8-12 DOI: 10.4103/JPN.JPN_97_17.
    CrossrefPubMedGoogle Scholar
  • 3 Bakshi S. Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report. Surg Case Rep 2020; 6 (01) 50
    CrossrefPubMedGoogle Scholar
  • 4 Panagea S, Cartmill TD, Panigrahi H. Intracerebral sepsis due to intestinal perforation by ventriculo-peritoneal shunts: two cases. J Infect 1997; 35 (01) 86-88 DOI: 10.1016/s0163-4453(97)91217-2.
    CrossrefPubMedGoogle Scholar
  • 5 Wilson CB, Bertan V. Perforation of the bowel complicating peritoneal shunt for hydrocephalus. Report of two cases. Am Surg 1966; 32 (09) 601-603
    PubMedGoogle Scholar
  • 6 Handa R, Kale R, Harjai MM. Unusual complication of ventriculoperitoneal shunt: anal extrusion. Med J Armed Forces India 2007; 63 (01) 82-84 DOI: 10.1016/S0377-1237(07)80122-5.
    CrossrefPubMedGoogle Scholar
  • 7 Zhou F, Chen G, Zhang J. Bowel perforation secondary to ventriculoperitoneal shunt: case report and clinical analysis. J Int Med Res 2007; 35 (06) 926-929 DOI: 10.1177/147323000703500624.
    CrossrefPubMedGoogle Scholar
  • 8 Bales J, Morton RP, Airhart N, Flum D, Avellino AM. Transanal presentation of a distal ventriculoperitoneal shunt catheter: Management of bowel perforation without laparotomy. Surg Neurol Int 2016; 7 (Suppl. 44) S1150-S1153
    CrossrefPubMedGoogle Scholar
  • 9 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. J Indian Assoc Pediatr Surg 2011; 16 (01) 31-33 DOI: 10.4103/0971-9261.74521.
    CrossrefPubMedGoogle Scholar
  • 10 Sharma A, Pandey AK, Radhakrishnan M, Kumbhani D, Das HS, Desai N. Endoscopic management of anal protrusion of ventriculo-peritoneal shunt. Indian J Gastroenterol 2003; 22 (01) 29-30
    PubMedGoogle Scholar