Transanal Extrusion of Ventriculoperitoneal Shunt Tubing in a Pediatric Patient.
Tomas Leng, John Dunlop
✦ AI-curated · Sources linked
Case in brief
A 12-year-old boy with hydrocephalus and a ventriculoperitoneal (VP) shunt was brought to the emergency department after tubing appeared in his stool. He was well appearing, neurologically at baseline, and had no abdominal or shunt-malfunction symptoms; examination and initial shunt imaging were reassuring. Because the tubing had passed per rectum, clinicians suspected bowel perforation. Surgical exploration found that the functioning shunt had perforated the colon and formed a fistulous tract. The shunt was externalized and the colonic defect repaired. Cerebrospinal fluid cultures grew gram-negative organisms, prompting shunt removal, external ventricular drainage, and prolonged antimicrobial therapy.
What made this case unusual
The functioning shunt had perforated the colon despite the child’s lack of abdominal symptoms and reassuring initial imaging; the tubing’s passage in stool was the key warning sign.
Diagnostic / clinical pearl
Transanal passage of VP shunt tubing warrants urgent evaluation for bowel perforation even when examination and initial imaging are reassuring, with prompt surgical and neurosurgical involvement.
Why it matters
Bowel perforation can allow ascending infection: in this case, cerebrospinal fluid cultures grew gram-negative organisms and further shunt-directed treatment was required.