Bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement that can result in anal protrusion of a VP shunt. Retrograde migration of bacteria through the shunt can lead to central nervous system (CNS) infections, such as meningitis, most commonly caused by Escherichia coli or other enteric pathogens. Here we present a case of methicillin-resistant Staphylococcus aureus (MRSA) meningitis from transanal migration of a VP shunt.
A 2-month old female with a history of VP shunt placement presented to the emergency department (ED) after her mother noticed a tube in the patient's diaper. On examination, a white tube was noted to be protruding from the patient's anus. Plain radiographic shunt series showed an intact VP shunt terminating outside of the patient's body. Cerebrospinal fluid (CSF) cultures grew MRSA. A diagnosis of MRSA meningitis secondary to spontaneous bowel perforation of a VP shunt was made. The patient went to the operating room for externalization of her shunt.
Why Should an Emergency Physician Be Aware of This?
To our knowledge, this is the first case of MRSA meningitis following transanal migration of a VP shunt to be reported in the literature. While anal protrusion of a VP shunt is rare, CNS infection from this complication results in a high mortality rate. In addition, not all cases of bowel perforation from a VP shunt will present with the shunt exiting the body. Therefore, in a patient with a history of a VP shunt who presents with symptoms of meningitis, it is important for emergency physicians to heavily consider intestinal perforation by VP shunt as a possible etiology.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- spontaneous bowel perforation from distal catheter leading to meningitis: a rare but frequently overlooked complication of ventriculoperitoneal shunts.Pediatr Neurol. 2013; 48: 477-478
- Perforation into gut by ventriculoperitoneal shunts: a report of two cases and review of the literature.J Indian Assoc Pediatr Surg. 2011; 16: 31-33
- Protrusion of a peritoneal catheter via abdominal wall and operated myelomeningocele area: a rare complication of ventriculoperitoneal shunt.Child Nerv Syst. 2013; 29: 1199-1202
- Transanal presentation of a distal ventriculoperitoneal shunt catheter: management of bowel perforation without laparotomy.Surg Neurol Int. 2016; 7: 1150-1153
- Unusual ventriculoperitoneal (VP) shunt tube extrusion through anus in a child with Dandy Walker malformation: a rare case report.J Clin Diagn Res. 2015; 9: 25-26
- Transanal protrusion of ventriculoperitoneal shunt via appendicular perforation: a rare case report.J Pediatr Neurosci. 2016; 11: 274-276
- Ventriculoperitoneal shunt catheter protrusion through the anus: case report of an uncommon complication and literature review.Child Nerv Syst. 2012; 28: 343-344
- Anal extrusion of the ventriculoperitoneal shunt catheter.Acta Med Acad. 2017; 46: 65-66
- Ventriculo-peritoneal shunt trans-anal protrusion causing Escherichia coli ventriculitis in child: case report and review of the literature.Chin Neurosurg J. 2017; 3: 9
- Asymptomatic perforation of large bowel and urinary bladder as a complication of ventriculoperitoneal shunt: report of two cases.Srp Arh Celok Lek. 2012; 140: 211-215
- Transanal protrusion of ventriculoperitoneal shunt reflecting asymptomatic perforation of the large bowel.BMJ Case Rep. 2014; 2014: 1-3
- Spontaneous transanal protrusion of ventriculoperitoneal catheter: a case report.Acta Med Iran. 2013; 51: 135-138
- Community-associated methicillin-resistant Staphylococcus aureus.Clin Infect Dis. 2005; 41: 269-272
- Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report.Cases J. 2009; 2: 8251
- Spontaneous bowel perforation after ventriculoperitoneal shunt surgery: case report and a review of 45 cases.Surg Neurol. 2000; 54: 388-396
Published online: August 08, 2019
Accepted: June 15, 2019
Received in revised form: May 30, 2019
Received: April 22, 2019
© 2019 Elsevier Inc. All rights reserved.