A Rare Complication of Ventriculoperitoneal Shunt: Asymptomatic Small Bowel Perforation (original) (raw)
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Srpski arhiv za celokupno lekarstvo, 2012
Introduction. Insertion of a ventriculoperitoneal (VP) shunt, the method of choice in the treatment of hydrocephalus, is often followed by various mechanical and/or infective complications. We present two children with asymptomatic perforation of the large bowel and urinary bladder, relatively rare and potentially severe complications of this surgical procedure. Outline of Cases. In both patients a VP shunt was implanted in the first month after birth; in a boy due to congenital hydrocephalus and in a girl due to the consequences of intracranial haemorrhage. Immediately after surgery, as well as during the further course, in both children growth and development were optimal and without any signs of infection or VP shunt malfunction. In the boy at age 6 months and in the girl at age 4 years, without any signs of complications, mothers noted the prominence of the VP shunt tip from the anus in the first case and from the urethral orifice in the second one. The VP shunts were immediatel...
Bowel Perforation and extrusion of a ventriculo-peritoneal shunt through the anus
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Ventriculo-peritoneal shunt (VPS) is one of the most commonly used procedures in the treatment of hydrocephalus. Nevertheless, even being technically simple and well-known, there are several serious complications that can happen, and among them is bowel perforation. This complication is rare, especially in adults, and it usually happens within the first year after the surgical procedure. It can also be aggravated by both infections, in the central nervous system or systemic, and also by increase in the intracranial pressure, due to shunt system dysfunction. The symptoms are usually mild, what can make the diagnosis challenging, and demanding several complementary tests. Also, there are many questions about the pathophysiology and predisposing factors for this complication. Due to its low incidence, and because it is usually described through case reports and small series, there is no consensus regarding its ideal management. The treatment varies from less invasive approaches, preser...
Cureus
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Background: Cerebrospinal fluid shunting is the most commonly performed surgical procedure in the management of hydrocephalus. Although frequently performed, this procedure is not free of complications. Case description: We report a case of non-described shunt migration, in which the ventricle-peritoneal catheter, at the mediastinum level, crosses to the contralateral side. Conclusion: When we are faced with complications after ventriculoperitoneal shunt surgeries, we should consider unusual or even unpredictable possibilities.
The ventriculoperitoneal shunt has been the preferred therapy for chronic hydrocephalus for a long time. Complications of this therapy include pseudocyst formation, perforation of the gastrointestinal tract, penetration into solid organs/abdominal wall, protrusion outside the body, disconnection and infection. Bowel perforation is rare complication of VP shunt placement [8]. Silent colonic perforation by ventriculoperitoneal shunt catheter and later patient presenting with catheter prolapsing from anal opening is seen less frequently [1]. We had 3 children 1-3 years old a case of hydrocephalus with ventriculoperitoneal shunt presenting in above scenario. Patients were completely asymptomatic with no features of toxemia indicating a chronic process [2]. Treatment involves pediatric surgical help in removing the shunt catheter, waiting for a sterile cerebrospinal fluid sample via repeated cultures and replacement of shunt catheter in a different quadrant in abdominal cavity.
Ventriculoperitoneal shunt malfunction: Presentation of 2 case reports and review of the literature
Journal of Dr Behcet Uz Children's Hospital, 2013
This study was carried out to focus on two unusual complications due to ventriculoperitoneal shunts (VPSs) performed in hydrocephalic children. Management of these patients with a special emphasis on the foregoing literature concerning the migration of shunt catheter into the scrotum is reviewed and discussed. Methods: A retrospective clinical study performed in patients with complications of VPS causing acute abdomino-scrotal conditions in two different centers between 2002-2012 is presented in the current study. Results: There are two pediatric cases with diagnosis of hydrocephaly and complications of VPS during the study period. Age, mode of presentation, results of treatment were studied. Apart from physical examination and radiological investigations, diagnosis of VPS complication was confirmed during surgical procedures in our patients. Conclusion: Complications of intestinal obstruction and protrusion of the VPS catheter into the scrotum are rarely seen in hydrocephalic children with VPS. Early identification and management of these complications is recommended for that they may cause life-threatening acute abdomino-scrotal conditions. ÖZET Amaç: Bu çalışmada hidrosefalik çocuklarda ventriküloperitoneal şant (VPŞ) uygulamasına ait alışık olunmayan iki komplikasyon sunulmuştur. Bu çocukların yönetimi özellikle şant kateterinin skrotal migrasyonuna ilişkin literatürler ışığında değerlendirilip tartışılmıştır. Yöntemler: Bu retrospektif kesitsel çalışmada iki ayrı merkezde 2002 ile 2012 yılları arasında akut abdomen ve akut skrotal şişme tablosu oluşturan VPŞ komplikasyonlu olgular sunularak tartışılmıştır. Bulgular: Çalışma dönemi içerisinde hidrosefali tanısı almış ve VPŞ komplikasyonu gelişmiş iki olgu bulunmaktadır. Yaş, klinik yansıma şekli, tedavi sonuçları çalışılmıştır. Fizik muayene ve radyolojik görüntüleme yöntemleri dışında VPŞ komplikasyon tanısı cerrahi tedavi sırasında doğrulanmıştır. Sonuç: Hidrosefalik VPŞ kateterli olgularda intestinal obstrüksiyon ve şant kateterinin skrotuma protrüzyonu nadiren görülür. Yaşamı tehdit edebilen akut abdominoskrotal durumlar oluşturabileceğinden bu komplikasyonların erken tanı ve tedavisi önerilmektedir.
Update about ventriculoperitoneal shunts: When to combine visceral and neurosurgical management?
Journal of Visceral Surgery, 2019
Ventriculoperitoneal shunts (VPS) are the treatment of choice for chronic hydrocephalus. However, the rate of abdominal complications is far from negligible. Combined abdominal and neurological surgical management is often necessary. The goal of this study was to describe the abdominal complications related to VPS and their management. This update overviews: (1) acute or chronic abdominal complications after insertion of a VPS, especially those that call for involvement of visceral surgeons; and (2) the particular precautions necessary when neurosurgeons and visceral surgeons have to collaborate in case an abdominal operation is necessary in patients with a VPS.
Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report
Cases Journal, 2009
Ventriculoperitoneal shunt placement is an effective treatment of hydrocephalus diverting the cerebrospinal fluid into the peritoneal cavity. Unfortunately, the shunt devices have a high incidence of malfunction mainly due to catheter obstruction or infection and are associated with various complications, 25% of which are abdominal. Spontaneous bowel perforation is a rare potentially fatal complication of ventriculoperitoneal shunt occurring anytime, few weeks to several years, after the placement of the ventriculoperitoneal shunt device. A 54-year-old Greek man with spontaneous perforation of sigmoid colon as a complication of distal ventriculoperitoneal shunt migration was treated successfully by antibiotic prophylaxis and abdominal surgery. Clinicians managing patients with ventriculoperitoneal shunt must be familiar with its possible complications and be aware for early recognition of them.