Unusual complication due to ventriculo-peritoneal shunt which peritoneal end perforated the rectum and protruded out of the anus: Report of a case

Abstract

We encountered a rare complication of ventriculo-peritoneal shunt (VP shunt) in which the peritoneal end of the shunt had perforated the rectum and protruded outside the anus. A VP shunt had been implanted in a 74-year-old man in the previous hospital to treat normal pressure hydrocephalus caused by intracerebral bleeding. Ten months later, he was admitted to the neurosurgery department of our hospital for meningitis and was treated successfully with antibiotics. Three months after admission, the peritoneal end of the catheter was found to be protruding from his anus. The abdomen was soft, and there was no tenderness or signs of peritoneal irritation. Laboratory studies revealed a white blood count of 6,400/mm3 and C-reactive protein of 1.9 mg/dl. Colonoscopy showed the peritoneal end of the catheter protruding through the rectal wall on the right side, 10 cm from the anal verge. The catheter was successfully extracted from the anus without subsequent signs of peritonitis. One week later, a gastrografin enema X-ray study revealed no leakage of gastrografin, and oral feeding was started. Bowel perforation by a VP shunt is rare, but it is a complication that should be borne in mind.