Unusual Complication of Ventriculoperitoneal Shunt Placement

Closed-Loop Bowel Obstruction Induced by Ventriculoperitoneal Shunt Catheter Coiling at the Sigmoid Colon: A Case Report

Intestinal obstruction is a rarely encountered complication in patients with ventriculoperitoneal (VP) shunt. The most common causes of bowel obstruction in this subset of patients include volvulus, formation of a spontaneous knot, and adhesions. Herein, we report a 21-year-old bedridden male with a history of congenital hydrocephalus on VP shunt, spina bifida, neurogenic bladder, and paraplegia who presented with a seven-day history of abdominal discomfort, distention, constipation, vomiting, and intolerance to oral intake. Abdominal x-ray showed dilated bowel loops. Computed tomography (CT) of the abdomen demonstrated a closed-loop bowel obstruction at the level of the sigmoid colon caused by the coiling of the VP shunt catheter. Diagnostic laparoscopy revealed the VP shunt tube coiling around a segment of the sigmoid colon with no signs of bands, ischemia, or perforation. Pulling and shortening of the tube was done. The procedure went uneventfully, and the patient was discharged home in stable condition. Maintaining a high index of suspicion for knotting the peritoneal catheter around the bowel is crucial when a patient on a VP shunt presents with a picture suggestive of intestinal obstruction. Early surgical intervention might be required to prevent further progression and complications.

The shadow in the darkness: Case report on adhesive intestinal obstruction secondary to ventriculoperitoneal shunt catheter in an elderly patient

Introduction

Shunt placement is an effective therapy for hydrocephalus. Ventriculoperitoneal shunt draining excess cerebrospinal fluid connects the cerebral ventricles to the abdominal cavity. However, intestinal obstruction may ensue as an infrequent complication of the shunt.

Case presentation

A 65 years old female patient presented with abdominal pain, abdominal bloating, and ceased passage of flatus and stool for six days. She had a history of undergoing a VP shunt procedure due to midbrain obstruction and supratentorial hydrocephalus. Conservative treatment at another local hospital couldn't relieve her symptoms. Laboratory investigations revealed elevated CRP and neutrophils. CT scan showed distended small bowel loops with aerated effusion. Thus, she was admitted to our hospital and underwent an emergent laparotomy following diagnostic modalities completion.

Discussion

Adhesive intestinal obstruction secondary to ventriculoperitoneal shunt is a rare but fatal shunt complication. The possible mechanisms involved include rubbing movements between the greater omentum and the catheter, cerebrospinal fluid reaction with abdominal organs, immunological rejection of the catheter, and deposition of brain tumor cells with the resultant abdominal metastatic lesions. Laparoscopic and laparotomy are warranted in the surgical management of the disease.

Conclusion

A high index of suspicion for adhesive intestinal obstruction is key to timely diagnosis and treatment.

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Ventriculoperitoneal (VP) shunt is the standard treatment for hydrocephalus.

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The common complications include bacterial infection and shunt malfunction.

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Adhesive intestinal obstruction is an infrequent VP catheter complication.

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Focused history, physical examination, and diagnostic modalities are of value.

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In emergencies, laparotomy is key in alleviating the disease's detrimental effects.

Early Anal Protrusion of Distal Ventriculoperitoneal Catheter Due to Iatrogenic Colonic Perforation: A Case Report and Review of Literature

Ventriculo-peritoneal (VP) shunt is one of the most commonly used therapeutic methods for hydrocephalus. And the incidence across the world of VP shunt complications varies from 20% to 45%. One of the rare complications is the catheter perforation of the abdominal viscera and its extrusion through the anal cavity. For the first time in the literature, this report addresses the presentation of iatrogenic perforation of the colon while inserting the peritoneal catheter of VP shunt.

Here, we present the case of a 15-year-old boy who is known to have cerebral palsy and congenital hydrocephalus with a VP shunt since birth. He presented to the ER with a history of headache and episodes of vomiting and was diagnosed with VP shunt dysfunction. The patient was taken for an emergency operation for shunt revision and a new shunt was placed. Then the next day he developed signs and symptoms of peritonitis with the distal part of the catheter protruding from the anal cavity, the patient was taken to the operating room for an exploratory laparotomy, the distal catheter was removed and replaced with external ventricular drainage, intra-operatively it was shown that the catheter was inserted directly into the colon causing bowel perforation, This report raises important questions about the nature of VP shunt bowel perforation and discusses management options.