Shunt malfunction in patients with hydrocephalus: complications revisited.

To cite: Hegde A, Nair RP, Ganapathy S, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015213619 DESCRIPTION The ventriculoperitoneal shunt has been the mainstay for definitive treatment of hydrocephalus since time immemorial. As such, several case reports describing the complications of this procedure have been documented in the literature over the past few decades. The spectrum ranges from ventricular catheter dislodgement to abdominal catheter end perforating the stomach and causing intussusception; several case illustrations have depicted the possible aftermath of this blind procedure. After the advent of neuronavigation and planning procedures on CT scans, the complication rates have significantly reduced. Shunt malfunction, secondary to migration of the abdominal end, remains as one of the most common complications following ventriculoperitoneal shunting. Large bowel perforation is a rare complication with an incidence of 0.1–0.7%. In rare instances, there have been cases of herniation of the peritoneum along with the distal end of the catheter through a lax posterior rectus sheath. The unprecedented cases we describe, the first of a child and the other of an elderly woman, mandate a separate mention in the literature. We present our institutional experience, treatment dilemma, surgical management and outcomes in both the patients. Case 1: A 11⁄2-year-old boy presented with intermittent appearance of the distal end of a ventriculoperitoneal shunt tube at the anus, while attempting to pass stools. The mother said that the child had been treated for obstructive hydrocephalus with a medium pressure Chhabra shunt, 9 months prior. On neurological examination, the child was active and alert; he had acquired appropriate milestones for his age and had no meningeal signs. The shunt chamber seemed to be functioning well. He was investigated with a shunt series X-ray, which revealed the distal end of the shunt tube traversing the entire lumen of the large intestine and ending in the sigmoid colon (figure 1A). A CT scan (brain CT) was ordered, which showed a significant