Silent bowel perforation cause by migration of ventriculoperitoneal shunt masquerading as acute enteritis

Abstract

Ventriculoperitoneal (VP) shunt is an established method of diverting cerebrospinal fluid for the management of hydrocephalus. The procedure is associated with various complications. Bowel perforation caused by migration of VP shunt is rare but serious complication. Because most of the patients are asymptomatic, and the occurrence of such complication is fatal due to ascending meningitis, early diagnosis, and rapid treatment is important in these patients. The diagnosis of such complication is based on direct visual of the protruding tube from the anus or abdominal computed tomography. Colon perforation due to shunt catheter migration may initially but not essentially present as meningitis after shunt infection, abdominal symptoms, seizure, and fever. However, colon perforation may rarely resemble the symptoms of acute gastroenteritis (abdominal pain, vomiting and/or diarrhea) before the prolapse of shunt catheter from the rectum. Here, we report a 75-year-old man underwent VP shunt for hydrocephalus presented with watery diarrhea masqueraded as acute gastroenteritis and further diagnosed as migration of VP shunt from the colon, via digital examination and further disclosed by computed tomography.