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[Perforation of the intestine by a peritoneal tube 10 years after a ventriculo-peritoneal shunt]
Insights
A ventriculoperitoneal (V-P) shunt tube perforated the bowel 10 years after implantation, a rare complication. This case highlights the potential for delayed intestinal perforation due to shunt encasement and friction.
Area of Science:
- Neurosurgery
- Gastroenterology
- Medical Device Complications
Background:
- Normal pressure hydrocephalus (NPH) is often treated with a ventriculoperitoneal (V-P) shunt.
- V-P shunts divert cerebrospinal fluid to the peritoneal cavity.
- Complications can arise, including shunt malfunction and infection.
Observation:
- A 49-year-old male presented with an abscess 10 years after V-P shunt placement for NPH.
- CT scans revealed the peritoneal tube had perforated the bowel.
- Surgical exploration showed fibrous tissue encasing the tube at the perforation site.
Findings:
- Intestinal perforation by a V-P shunt tube occurred 10 years post-implantation.
- The perforation is attributed to continuous friction from the encased shunt tube against the bowel.
- This represents the longest reported interval between V-P shunt placement and intestinal perforation.
Implications:
- Delayed intestinal perforation is a rare but serious V-P shunt complication.
- Chronic friction and fibrous encapsulation may predispose to bowel perforation.
- Long-term V-P shunt surveillance is crucial for early detection of such delayed complications.
Abstract:
A case is reported of intestinal perforation by a ventriculoperitoneal shunt (V-P shunt) tube 10 years after V-P shunt. A 49-year-old male received V-P shunt for normal pressure hydrocephalus following subarachnoid hemorrhage. Ten years later he was admitted to our department with an abscess on the anterior chest and on the abdominal wall along the shunt tube. When CT scan revealed that the peritoneal tube had perforated the bowel, the shunt was removed. During the operation it was found that the peritoneal tube was wrapped with fibrous tissue and that it had perforated the intestine. The subcutaneous abscess healed after the patient received systemic antibiotics. He was discharged and returned to work. We discussed the mechanism of bowel perforation in this case. It is assumed that bowel perforation occurred because of continuous friction at the same site of the bowel wall after the peritoneal tube received fibrous encasement in the abdominal cavity. Bowel perforation was diagnosed ten years after the V-P shunt in this case. To our knowledge, this is the longest period amongst reported cases.