Martinez Hernández-Magro P, Barrera Román C, Villanueva Sáenz E, Zavala M J
Colon and Rectal Surgery Department, Speciality Hospital National Medical Center 21st Century IMSS, Mexico City, Mexico.
Tech Coloproctol. 2006 Dec;10(4):353-5. doi: 10.1007/s10151-006-0308-8. Epub 2006 Nov 27.
Late perforation after ventriculoperitoneal (VP) shunting is extremely rare. Colonic perforation is uncommon and represents 0.1%-0.7% of abdominal complications. Colonic perforation can challenge diagnostic and therapeutic decisions, and there are no clear guidelines on the management of this problem. We present a 34-year-old woman who was admitted for a 1-week history of sensation of a foreign body through the anus at the time of bowel movements. She had previously undergone a VP derivation for hydrocephalus secondary to neurocysticercosis. Plain abdominal radiographs demonstrated the shunt within the colonic lumen and through the descendening and sigmoid colon. The shunt was exteriorized in the cervical area and a laparotomy was performed with a primary two-layer colonic close. The patient received antibiotic therapy for 2 weeks with good outcome. Percutaneous and endoscopic approaches have been reported in patients with no abdominal signs. Prompt recognition of this complication is critical to avoid high mortality rates.
脑室腹腔（VP）分流术后迟发性穿孔极为罕见。结肠穿孔并不常见，占腹部并发症的0.1%-0.7%。结肠穿孔会给诊断和治疗决策带来挑战，目前对于该问题的处理尚无明确指南。我们报告一名34岁女性，因排便时有经肛门异物感1周入院。她曾因神经囊尾蚴病继发脑积水接受过VP分流术。腹部平片显示分流管位于结肠腔内，通过降结肠和乙状结肠。分流管在颈部外置，行剖腹手术并对结肠进行一期两层缝合。患者接受了2周抗生素治疗，效果良好。对于无腹部体征的患者，已有经皮和内镜治疗方法的报道。及时识别这种并发症对于避免高死亡率至关重要。
