Rectal penetration by a disconnected ventriculoperitoneal shunt tube: an unusual complication

One case involving rectal penetration by a ventriculoperitoneal (VP) shunt tube is presented. A 16-year-old male patient had undergone right-sided VP shunting to treat hydrocephalus at the age of 4 months. Because a dysfunction of the VP shunt was noted, a revision was performed at the age of 4 years. Surprisingly, the tube could not be found; therefore, a new tube was inserted. At the age of 11 years, another shunt revision was performed on the other side due to an obstruction of the VP tube. At the age of 16 years, the patient noticed a tube partially protruding from his anus while defecating, without any associated symptoms. The tube was successfully removed by colonoscopy. Unfortunately, peritonitis developed the next day. Laparotomy was performed and a severe local inflammation was noted in the pelvic cavity. A sigmoid loop colostomy was performed for stool diversion. The postoperative course went smoothly and the colostomy was closed 3 months later. This case demonstrates an unusual complication of a VP shunt 12 years after disconnection. We should bear in mind the possibility of tube migration into the abdominal cavity and subsequent bowel penetration if a patient develops abnormal abdominal conditions. If there is no obvious peritoneal sign, this kind of patient can be conservatively treated after colonoscopic removal of the tube. However, if peritonitis develops, laparotomy should be performed for further evaluation and treatment.