Complex complications following ventriculoperitoneal shunt placement in Syria: A case report on multiple bowel perforations, migration, and obstruction.

Introduction: 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.

Case Presentation: 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.

Discussion: 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.

Conclusion: 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.