CAUDAL MIGRATION AND TRANS-ANAL EXTRUSION OF VENTRICULOPERITONEAL SHUNT IN A CHILD : A CASE REPORT

Abstract

Ventriculo-peritoneal shunts are one of the commonest surgical procedures performed in neurosurgery for diversion of cerebrospinal uid for hydrocephalus. Excess amount of cerebrospinal uid is drained unidirectionally from obstructed ventricular cavities into the peritoneum in the management of hydrocephalus. VP shunt sometimes causes complications. Complications can be mechanical ( obstruction, disconnection and migration ) or non mechanical (infection and distal compartment related like pseudocyst 1,2 formation , ascites and pleural effusion). Migration can be dened as translocation of the part/ whole of the shunt system (proximal/ distal catheter / reservoir/ valves ) from the compartment where it was intended to be to a new compartment which may be associated with/ without shunt dysfunction. In general, a caudal migration is more common 3 than a cranial migration. Bowel perforation caused by the ventriculo-peritoneal shunt is a rare occurrence with an estimated incidence rate of 0.1% to 1.0% among all cases of VP shunt displacement. Perforation of the bowel wall by VP shunt is a surgical emergency. Awareness and early recognition of this complication are essential because of the 4 high mortality rate in such patients. In this present case report, a 5 year olds male child presented with anal protrusion of VP shunt with fever and signs of shunt malfunction. Early diagnosis and treatment of this complication is essential to minimize or prevent infectious and neurological consequences