Bowel perforation by lumbar-peritoneal (LP) shunt: A rare complication of neurosurgery

Primary adrenal insufficiency developed 22 years after the diagnosis of light and heavy chain deposition disease: a case report

Monoclonal immunoglobulin deposition diseases (MIDDs), including light and heavy chain deposition disease (LHCDD), are rare and heterogeneous disorders associated with underlying B-cell clonal disorders. Adrenal involvement is a potential extrarenal manifestation of MIDDs; however, limited data are available regarding its prevalence and clinical presentation. Herein, the present report describes, for the first time, a case of primary adrenal insufficiency that developed twenty-two years after a diagnosis of LHCDD had been made. A 69 year-old woman with a 10 year history of hemodialysis suddenly became bedridden after falling down stairs in the absence of focal neurological deficits. Subsequently, she experienced appetite loss, nausea, vomiting, a fever of unknown origin, and unexplained hypotension. Several months later, primary adrenal insufficiency and normal pressure hydrocephalus were diagnosed and successfully managed. The long-term clinical prognosis of MIDDs has not been fully elucidated despite recent advances in the management of the disorders. This report may contribute to improving our understanding of the disease course.

Duodenal perforation as a postoperative complication after ventriculoperitoneal shunt: A case report

INTRODUCTION AND IMPORTANCE

Ventriculoperitoneal shunt (VP shunt) is the one of the most common and important tools for the treatment of hydrocephalus. It requires simple technique and demonstrates effectiveness in treating hydrocephalus. However, many complications have been reported such as infection, valve obstruction, valve dysfunction and abdominal complications. Complications of intestinal perforation and catheter penetrating the intestine are very rare, accounting for 0.01-0.07% of abdominal complications. In the literature, 94 cases of intestinal perforation and catheter penetration and only 2 cases of duodenal perforation have been reported.

CASE PRESENTATION

In this study, we report a successful surgical treatment of a duodenal perforation complication after 5 months of VP shunt. Gastroscopy showed the distal tip penetrating into the D2 segment of the duodenum. Surgery was performed to relocate the abdominal tip and to repair the perforation. Meningitis was treated with antibiotics. The patient was stable and discharged after 3 weeks.

CLINICAL DISCUSSION

The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.

CONCLUSION

Intestinal perforation with VP shunt catheter is rare. Diagnosis is simple if the catheter comes out of the anus, mouth, vagina, penis, scrotum, navel. In case when the catheter is inside the lumen of the gastrointestinal tract, diagnosis often requires imaging such as abdominal computed tomography, and gastrointestinal endoscopy. Surgery treatment was to replace the drainage valve and to close the perforation the digestive tract.

A unique strategy for large-bowel perforation with ventriculoperitoneal shunt: Conversion to ventriculoatrial shunt: A case report

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Large-bowel perforation can lead to critical sepsis, and urgent intervention including surgery is indispensable to control systemic infection.

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We describe a strategy for large-bowel perforation using a ventriculoperitoneal shunt that was converted to a ventriculoatrial shunt and discuss its utility based on the literature.

Introduction

Large-bowel perforation can lead to critical sepsis, and urgent intervention including surgery is indispensable to control systemic infection. Here, we describe a strategy for large-bowel perforation using a ventriculoperitoneal shunt.

Case presentation

A 74-year-old Japanese female with a history of cerebral aneurysm clipping and ventriculoperitoneal shunting due to aneurysmal subarachnoid hemorrhage presented with lower abdominal pain, fever, and disturbed consciousness. Clinical findings indicated a diagnosis of large-bowel perforation and ventriculoperitoneal shunt-transmitted bacterial meningitis. Thus, sigmoidectomy and shunt externalization were performed, and the ventriculoperitoneal shunt was converted to a ventriculoatrial one.

Conclusion

Based on our experience and the literature, we successfully discuss bowel perforation management with respect to the ventriculoperitoneal shunt, including the utility of the ventriculoatrial shunt as an alternative.