• Surg Neurol Int · Jan 2016

    Case Reports

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

    • James Bales, Ryan P Morton, Nathan Airhart, David Flum, and Anthony M Avellino.
    • Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
    • Surg Neurol Int. 2016 Jan 1; 7 (Suppl 44): S1150-S1153.

    BackgroundBowel 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 DescriptionWe 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.ConclusionsA 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.

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