Endoscopy 2003; 35(5): 463
DOI: 10.1055/s-2003-38763
Unusual Cases and Technical Notes

© Georg Thieme Verlag Stuttgart · New York

A Rare Complication of a Ventriculoperitoneal Shunt Resolved by Colonoscopy

E.  Pikoulis 1 , N.  Psallidas 2 , P.  Daskalakis 1 , K.  Kouzelis 3 , A.  Leppäniemi 4 , P.  Tsatsoulis 1
  • 1 2nd Department of Surgery, General Hospital “Asclepeion” Voulas, Athens, Greece
  • 2 Endoscopic Unit, General Hospital “Asclepeion” Voulas, Athens, Greece
  • 3 Department of Neurosurgery, General Hospital “Asclepeion” Voulas, Athens, Greece
  • 4 Department of Surgery, Helsinki University, Finland
Further Information

E. Pikoulis, M.D.

2nd Department of Surgery
General Hospital “Asclepeion” Voulas

Aggelidou 5 Str.
Paleo Faliro, 17561
Athens
Greece

Fax: + 30-10-8959254

Email: Pikoulis@hellasnet.gr

Publication History

Publication Date:
17 April 2003 (online)

Table of Contents

In addition to the two most frequent complications of obstruction and infection, ventriculoperitoneal (VP) shunts have been associated with a pseudocyst, mesenteric pseudotumor, metastasis of cerebral tumors via the shunt, and protrusion of the distal catheter through the scrotum or vagina [1] [2]. Bowel perforation, especially of the colon, has been previously described in about 30 cases, usually in children [2].

A 33-year-old man underwent the insertion of a VP shunt for traumatic hydrocephalus. After 6 months, the protrusion of a strange structure through the anus during defecation was noted. Colonoscopic examination revealed that a part of the distal VP shunt had perforated the colon about 25 cm from the anus (Figure [1]). The distal part was grasped and pulled straight with a “crocodile” clamp while the tube was cut and ligated upon its proximal abdominal entry site through a small incision at the right hypochondrium, after which the residual tube was removed through the anus. The patient recovered without complications, and at follow-up colonoscopic examination 10 days later the rectal wound had healed completely.

Zoom Image

Figure 1 Part of the distal tube of the ventriculoperitoneal (VP) shunt had perforated the colon.

Perforation of an intra-abdominal hollow organ is a rare complication of a VP shunt and is associated with a 15 % mortality [1] [2]. A long-lasting adhesion of the catheter to the bowel may have led to its erosion, augmented by the stiff and sharp tip of the distal catheter [1] [3].

In the management of rectal perforation caused by a VP shunt, three options have been suggested: total removal of the shunt, conservative management with intravenous antibiotics, and external ventriculostomy until the cerebrospinal fluid (CSF) becomes sterile [1] [3] [4].

In the case discussed here, management consisted of colonoscopy-assisted removal of the peritoneal part of the catheter combined with antibiotic treatment, with good results.

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References

  • 1 Digray N C, Thappa D R, Arora M. et al. . Silent bowel perforation and transanal prolapse of a ventriculoperitoneal shunt.  Pediatr Surg Int. 2000;  16 94-95
  • 2 Ashpole R, Boulton R, Holmes A E.. A case of asymptomatic passage per-rectum of a fractured redundant peritoneal catheter from a ventriculo-peritoneal shunt.  Eur J Pediatr Surg. 1995;  5 280-281
  • 3 Jamjoom A B, Rawlinson J N, Kirkpatrick J N.. Passage of tube per rectum: an unusual complication of a ventriculoperitoneal shunt.  Br J Clin Pract. 1990;  44 525-526
  • 4 Schulhof L A, Worth R M, Kalsbeck J E.. Bowel perforation due to peritoneal shunt. A report of seven cases and a review of the literature.  Surg Neurol. 1975;  3 265-269

E. Pikoulis, M.D.

2nd Department of Surgery
General Hospital “Asclepeion” Voulas

Aggelidou 5 Str.
Paleo Faliro, 17561
Athens
Greece

Fax: + 30-10-8959254

Email: Pikoulis@hellasnet.gr

#

References

  • 1 Digray N C, Thappa D R, Arora M. et al. . Silent bowel perforation and transanal prolapse of a ventriculoperitoneal shunt.  Pediatr Surg Int. 2000;  16 94-95
  • 2 Ashpole R, Boulton R, Holmes A E.. A case of asymptomatic passage per-rectum of a fractured redundant peritoneal catheter from a ventriculo-peritoneal shunt.  Eur J Pediatr Surg. 1995;  5 280-281
  • 3 Jamjoom A B, Rawlinson J N, Kirkpatrick J N.. Passage of tube per rectum: an unusual complication of a ventriculoperitoneal shunt.  Br J Clin Pract. 1990;  44 525-526
  • 4 Schulhof L A, Worth R M, Kalsbeck J E.. Bowel perforation due to peritoneal shunt. A report of seven cases and a review of the literature.  Surg Neurol. 1975;  3 265-269

E. Pikoulis, M.D.

2nd Department of Surgery
General Hospital “Asclepeion” Voulas

Aggelidou 5 Str.
Paleo Faliro, 17561
Athens
Greece

Fax: + 30-10-8959254

Email: Pikoulis@hellasnet.gr

Zoom Image

Figure 1 Part of the distal tube of the ventriculoperitoneal (VP) shunt had perforated the colon.