Abstract
Background
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.
Case Report
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.
Keywords
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Article info
Publication history
Published online: August 08, 2019
Accepted:
June 15,
2019
Received in revised form:
May 30,
2019
Received:
April 22,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
