Early Anal Protrusion of Distal Ventriculoperitoneal Catheter Due to Iatrogenic Colonic Perforation: A Case Report and Review of Literature

Ventriculo-peritoneal (VP) shunt is one of the most commonly used therapeutic methods for hydrocephalus. And the incidence across the world of VP shunt complications varies from 20% to 45%. One of the rare complications is the catheter perforation of the abdominal viscera and its extrusion through the anal cavity. For the first time in the literature, this report addresses the presentation of iatrogenic perforation of the colon while inserting the peritoneal catheter of VP shunt. Here, we present the case of a 15-year-old boy who is known to have cerebral palsy and congenital hydrocephalus with a VP shunt since birth. He presented to the ER with a history of headache and episodes of vomiting and was diagnosed with VP shunt dysfunction. The patient was taken for an emergency operation for shunt revision and a new shunt was placed. Then the next day he developed signs and symptoms of peritonitis with the distal part of the catheter protruding from the anal cavity, the patient was taken to the operating room for an exploratory laparotomy, the distal catheter was removed and replaced with external ventricular drainage, intra-operatively it was shown that the catheter was inserted directly into the colon causing bowel perforation, This report raises important questions about the nature of VP shunt bowel perforation and discusses management options.