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Colonic perforation by ventriculoperitoneal shunts
Abstract:
Two cases of colonic perforation by a ventriculoperitoneal shunt are presented. One was diagnosed by routine abdominal roentgenograms, the other by instilling metrizamide into the distal shunt tubing. A review of the 32 previously reported cases revealed a mortality of 15%. Bowel perforation from a ventriculoperitoneal shunt should be managed with intravenous antibiotics as well as removal of the shunt. If the patient has a benign abdominal examination and no prior history of abdominal complications from a ventriculoperitoneal shunt then the abdominal catheter can be removed percutaneously. However, in the presence of severe peritonitis, or a previous history of serious abdominal problems from the shunt catheter, such as an infected pseudocyst or other intraabdominal pathology, such as active regional enteritis or an abscess, we recommend laparotomy for removing the catheter with primary closure of the bowel perforation.
Insights
Colonic perforation by ventriculoperitoneal shunts is rare but serious, with a 15% mortality rate. Management involves antibiotics and shunt removal, with percutaneous or surgical catheter extraction based on patient condition.
Area of Science:
- Neurosurgery
- Gastroenterology
- Radiology
Background:
- Ventriculoperitoneal shunts are commonly used for hydrocephalus treatment.
- Complications can include shunt malfunction, infection, and rarely, bowel perforation.
- Colonic perforation by shunt tubing presents a diagnostic and management challenge.
Observation:
- Two cases of colonic perforation due to ventriculoperitoneal shunts are presented.
- Diagnosis was achieved through abdominal roentgenograms and metrizamide instillation.
- A literature review identified 32 prior cases with a 15% mortality.
Findings:
- Bowel perforation necessitates intravenous antibiotics and shunt removal.
- Percutaneous catheter removal is suitable for patients with benign abdominal exams and no prior complications.
- Laparotomy is recommended for severe peritonitis or significant intra-abdominal pathology.
Implications:
- Prompt diagnosis and appropriate management are crucial for reducing morbidity and mortality.
- Tailoring the approach to catheter removal based on clinical presentation optimizes patient outcomes.
- This highlights the importance of vigilance for gastrointestinal complications in patients with ventriculoperitoneal shunts.