[Complications resulting from ventriculo-peritoneal shunt: an anticipatory comment-case report (author's transl)]

Case is 23 year-old man, Who was admitted to the University Hospital with a diagnosis of acoustic neurinoma as a manifestation of von Recklinghausen's disease. V-P shunt was performed because of the increased intracranial pressure and post-operative course was complicated by repeated bout of meningitis. Otherwise, postoperative course was uneventful till about 7 month after placement of V-P shunt when the proximal end of the shunt tube perforated into the lumen of the intestine and about 30 cm length of shunt tube emerged from anus. Subsequently the patient developed meningitis. Nowadays, the tendency was noted that ventriculo-peritoneal shunt is more frequently performed than ventriculoauricular shunt and so increased incidences of complications attributable to the position of the tip of the shunt tube in theperitoneal cavity is naturally anticipated. In this report, we discussed the mechanism of development of intestinal perforation, its prophylactic measures and the earty diagnosis. Number one factor which is attributed to the cause of intestinal perforation is a fact that any intra-peritoneal foreign body is potentially able to cause intestinal perforation. The second factor is the sharp tip of the peritoneal shunt tlbe which more easily cause intestinal perforation than otherwise. The third factor is the constant pressure at the same location of the intestinal wall over a long period of time which is applied by a peritoneal tip, which is considered to cause necrosis of the intestinal wall. The fourth factor is relatively poor general condition of the patient and secondary decrease in resistance of the intestinal wall against the foreign body. We therefore postulate for the prophylaxis and early diagnosis that we should often check the position of the tip of the shunt tube end should performed the radiological evaluation at the first sight of peritoneal irritation sign. The architecture and the location of the tip of the tube, the length and material of the tube seem to have intimate relation to the prophylaxis against intestinal perforation and these factors have to be evaluated in the future.