Shbani Abdulrahman, Zainabo Asmaa, Zainabo Raghad, Alsayed Chaza, Ranjous Nazem
Tartous University, Faculty of Medicine, Tartous, Syrian Arab Republic.
Tishreen University, Faculty of Medicine, Lattakia, Syrian Arab Republic.
Int J Surg Case Rep. 2024 Nov;124:110348. doi: 10.1016/j.ijscr.2024.110348. Epub 2024 Sep 26.
In patients with hydrocephalus, the most effective technique since the early 1900s is through the implantation of a ventriculoperitoneal shunt (VPS). VPS can cause abdominal issues such as infection, bowel obstruction due to adhesions, or viscus perforation. In our patient, the combination of infection, bowel obstruction, multiple intestinal perforations, and anal migration of the shunt creates a unique blend of complications that may be caused by VPS.
A 17-year-old girl with a history of ventriculoperitoneal shunt placement presented with symptoms of bowel obstruction. During the anal palpation, the examiner felt a tubular object inside the rectal ampulla which was the shunt. Laparotomy revealed that the shunt catheter had perforated the jejunum, extended through the sigmoid colon, and into the rectum. The patient was treated with antibiotics and an external shunt was placed for three months, then placed through the jugular vein to the pericardial cavity.
Hydrocephalus treatment often involves ventriculoperitoneal shunts (VPS) with complications such as abdominal issues, infections, and bowel perforation. These issues occur in 24 %-47 % of cases. In a rare case, a patient experienced infection, anal shunt migration, bowel obstruction, and three perforations, starting from the jejunum and extending to the rectum. The patient's history of appendectomy and previous shunt complications may have predisposed them to the perforation.
The rare combination of infection, anal shunt migration, a bowel obstruction, and a perforations during hydrocephalus treatment highlights the critical need for comprehensive understanding of and monitoring for ventriculoperitoneal shunt complications. Prompt interdisciplinary intervention is essential due to the potential severity and mortality associated with these complex issues. Specific patient factors must be considered to optimize patient outcomes.
自20世纪初以来，对于脑积水患者，最有效的技术是植入脑室腹腔分流术（VPS）。VPS可引发腹部问题，如感染、因粘连导致的肠梗阻或脏器穿孔。在我们的患者中，感染、肠梗阻、多处肠穿孔以及分流管肛门移位的综合情况构成了一系列可能由VPS引起的独特并发症。
一名有脑室腹腔分流术植入史的17岁女孩出现肠梗阻症状。在肛门触诊时，检查者在直肠壶腹内摸到一个管状物体，即分流管。剖腹探查显示分流管导管已穿透空肠，经乙状结肠延伸至直肠。患者接受了抗生素治疗，并外置分流管三个月，之后经颈静脉置入心包腔。
脑积水治疗通常涉及脑室腹腔分流术（VPS），会出现腹部问题、感染和肠穿孔等并发症。这些问题在24% - 47%的病例中出现。在一个罕见病例中，一名患者经历了感染、分流管肛门移位、肠梗阻以及三处穿孔（从空肠开始并延伸至直肠）。患者的阑尾切除术病史和先前的分流并发症可能使其易发生穿孔。
脑积水治疗期间感染、分流管肛门移位、肠梗阻和穿孔的罕见组合凸显了全面了解和监测脑室腹腔分流术并发症的迫切需求。由于这些复杂问题可能带来的严重性和死亡率，及时的多学科干预至关重要。必须考虑特定的患者因素以优化患者预后。
