Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 50, Num. 1, 2002, pp. 107-108

Neurology India, Vol. 50, No. 1, March, 2002, pp. 108-109

Rare Shunt Complication : Letter to Editor

P. Bharti, T. Kumar, S. Bharti

Department of Neurosurgery, LLRM Medical College, Meerut, U.P. India.

Code Number: ni02032

We report a rare case of ventriculo peritonial shunt, in which shunt tip perforated a bowel loop and protruded out of anal opening. An 11 month old male child had been operated for post meningetic hydrocephalus at an age of two months and standard right ventriculo peritoneal shunt was placed. Patient was on regular follow-up. He started having recurrent fever nine months after surgery. One morning, patient's mother noted a white tube protruding out from anal opening (Fig. 1). He was brought to emergency department and removal of shunt was carried over. His abdomen remained soft and there was normal passage of feces in post operative period. However patient developed signs and symptoms of raised intracranial pressure and contrast CT brain revealed multiple abscesses and ventriculitis. Prognosis was explained to attendants who refused further treatment.

Shunt complications are very commonly seen in the form of blockage, broken or disengaged shunts. Rare complications have been noted by various authors in the form of obstruction, perforation of bowel, vagina or perforation through umblicus or entry into scrotum. Rectal perforation has been reported,^2,4 but is a rare complication, hence this report.

References

1. Agha MD, Amendola MA, Shirazi KK et al : Abdominal complications of ventriculo peritonial shunts with emphasis on the role imaging methods. Surg Gynecol Obstet 1983; 156 : 473-478.
2. Fernandes MA : Extrusion of ventriculo peritonial shunt through anus. Indian Pediatr 1989; 26 : 6-7.
3. Ignelzi RJ, Kirsch WM : Follow-up analysis of ventriculoperitonial and ventriculoatrial shunts for hydrocephalus. J Neurosurg1975; 42 : 679-682.
4. Jindal A, Kansal S, Mahapatra AK : Unsual complication - V.P Shunt coming out per rectum and brain abscess. Indian J Pediatr 1999; 66 : 463-465.
5. Murtagh RF, Quencer RM, Poole CA : Extracranial complications of cerebrospinal fluid shunt function in childhood hydrocephalus. AJR 1980; 135 : 763-766.

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