Anal Protrusion of Peritoneal End of Ventriculoperitoneal Shunt and Multiple Brain Abscesses: A Case Report With Review of Literature

Background and Importance: 

Ventriculoperitoneal shunt surgery is a widely accepted treatment for hydrocephalus, but it is not free from complications. Of all the complications, bowel perforation represents only 0.01-0.07% and it often presents with asymptomatic anal protrusion of the distal end of the ventriculoperitoneal shunt. The mechanism causing shunt ejection is unknown, but the most widely accepted theory is that after intestinal perforation, the tubing of the shunt is propelled out by the peristaltic movements in the gut.

Case Presantation: 

A case of a 3.5-year-old boy with anal protrusion of the peritoneal end of ventriculoperitoneal shunt and multiple brain abscesses is reported. In surgery, the ventriculoperitoneal shunt was divided at the clavicular region, and the peritoneal end was gently pulled out of the anus while the ventricular end was exteriorized. Empirical antibiotics, antiepileptics, and steroids were given. The culture and sensitivity report revealed no microorganisms. The child improved over a period of two weeks and then a new ventriculoperitoneal shunt was inserted on the opposite side.

Suspicion for bowel perforation must be kept high in symptomatic ventriculoperitoneal shunt patients even though most of the patients present with asymptomatic anal protrusion of the peritoneal end of ventriculoperitoneal shunt. In order to avoid infectious and neurological consequences, early identification and then subsequent treatment are crucial. The extruded end can easily be removed from the migrated orifice without the need for extensive surgery.