Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report
Abstract Background Bowel perforation caused by the ventriculo-peritoneal shunt is a rare occurrence with an estimated incidence rate of 0.1% to 1.0% among all cases of VP shunt displacement. This is an unusual report of spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shu...
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Japan Surgical Society
2020-03-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00813-0 |
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| author | Sabyasachi Bakshi |
| author_facet | Sabyasachi Bakshi |
| author_sort | Sabyasachi Bakshi |
| collection | DOAJ |
| description | Abstract Background Bowel perforation caused by the ventriculo-peritoneal shunt is a rare occurrence with an estimated incidence rate of 0.1% to 1.0% among all cases of VP shunt displacement. This is an unusual report of spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child. Literature was reviewed to find out therapeutic strategies. Case presentation An asymptomatic 8 months old boy presented with spontaneous trans-anal extrusion of caudally migrated left-sided Chhabra type of ventriculo-peritoneal (VP) shunt for last 1 day, following surgery for hydrocephalus initially done 3 months ago. He had no features of peritonitis or encephalitis. Digital X-ray of the whole abdomen in postero-anterior view in erect posture was only evident of the expulsion of radio-opaque distal catheter tip through the anus into the exterior. Noncontrast-enhanced computed tomography scan (NCCT) of brain showed proximal catheter in the lateral ventricle of the brain. Under sedation, the distal part of the VP shunt catheter was resected out, aseptically, over the abdomen and pulled out gently through the anus. The proximal catheter part along with the reservoir was removed through a separate incision in the neck and sent for bacteriological study, which came out later to be negative. Postoperatively, the child was put on a prophylactic antibiotic and 3 weeks later another VP shunt was placed in the contralateral side. Conclusions Spontaneous trans-anal extrusion of VP shunt tip is a surgical emergency. The whole catheter must be removed aseptically in such a way that both contamination of the cerebral cavity and spillage into the peritoneum can be avoided. Awareness of this unusual complication among surgeons is needed for early recognition, management, and timely intervention to minimize morbidity. |
| format | Article |
| id | doaj-art-e33f5947d5b9456490e070945754cdf0 |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-03-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-e33f5947d5b9456490e070945754cdf02025-08-20T03:57:52ZengJapan Surgical SocietySurgical Case Reports2198-77932020-03-01611410.1186/s40792-020-00813-0Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case reportSabyasachi Bakshi0IPGMER & SSKMHAbstract Background Bowel perforation caused by the ventriculo-peritoneal shunt is a rare occurrence with an estimated incidence rate of 0.1% to 1.0% among all cases of VP shunt displacement. This is an unusual report of spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child. Literature was reviewed to find out therapeutic strategies. Case presentation An asymptomatic 8 months old boy presented with spontaneous trans-anal extrusion of caudally migrated left-sided Chhabra type of ventriculo-peritoneal (VP) shunt for last 1 day, following surgery for hydrocephalus initially done 3 months ago. He had no features of peritonitis or encephalitis. Digital X-ray of the whole abdomen in postero-anterior view in erect posture was only evident of the expulsion of radio-opaque distal catheter tip through the anus into the exterior. Noncontrast-enhanced computed tomography scan (NCCT) of brain showed proximal catheter in the lateral ventricle of the brain. Under sedation, the distal part of the VP shunt catheter was resected out, aseptically, over the abdomen and pulled out gently through the anus. The proximal catheter part along with the reservoir was removed through a separate incision in the neck and sent for bacteriological study, which came out later to be negative. Postoperatively, the child was put on a prophylactic antibiotic and 3 weeks later another VP shunt was placed in the contralateral side. Conclusions Spontaneous trans-anal extrusion of VP shunt tip is a surgical emergency. The whole catheter must be removed aseptically in such a way that both contamination of the cerebral cavity and spillage into the peritoneum can be avoided. Awareness of this unusual complication among surgeons is needed for early recognition, management, and timely intervention to minimize morbidity.http://link.springer.com/article/10.1186/s40792-020-00813-0Trans-anal extrusionVP shuntHydrocephalus |
| spellingShingle | Sabyasachi Bakshi Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report Surgical Case Reports Trans-anal extrusion VP shunt Hydrocephalus |
| title | Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report |
| title_full | Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report |
| title_fullStr | Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report |
| title_full_unstemmed | Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report |
| title_short | Spontaneous trans-anal extrusion of caudally migrated ventriculo-peritoneal shunt tip in a child: a case report |
| title_sort | spontaneous trans anal extrusion of caudally migrated ventriculo peritoneal shunt tip in a child a case report |
| topic | Trans-anal extrusion VP shunt Hydrocephalus |
| url | http://link.springer.com/article/10.1186/s40792-020-00813-0 |
| work_keys_str_mv | AT sabyasachibakshi spontaneoustransanalextrusionofcaudallymigratedventriculoperitonealshunttipinachildacasereport |