Bowel Perforation and extrusion of a ventriculo-peritoneal shunt through the anus

Abstract

Ventriculo-peritoneal shunt (VPS) is one of the most commonly used procedures in the treatment of hydrocephalus. Nevertheless, even being technically simple and well-known, there are several serious complications that can happen, and among them is bowel perforation. This complication is rare, especially in adults, and it usually happens within the first year after the surgical procedure. It can also be aggravated by both infections, in the central nervous system or systemic, and also by increase in the intracranial pressure, due to shunt system dysfunction. The symptoms are usually mild, what can make the diagnosis challenging, and demanding several complementary tests. Also, there are many questions about the pathophysiology and predisposing factors for this complication. Due to its low incidence, and because it is usually described through case reports and small series, there is no consensus regarding its ideal management. The treatment varies from less invasive approaches, preserving the shuntcomponents in place, until the full withdrawn of the whole system and use of wide spectrum antibiotics. We report a delayed case of bowel perforation and catheter extrusion through the anus in an adult patient, discussing the data available about this pathology.