title: Bowel perforation presenting with acute abdominal pain and subcutaneous emphysema in a 14-year-old girl with an abandoned distal peritoneal shunt catheter: case report.
abstract: The authors report the case of 14-year-old girl with a history of myelomeningocele and previously shunt-treated hydrocephalus who presented with right-sided abdominal pain and subcutaneous emphysema that developed over a 1-week period. A CT scan of the patient's abdomen revealed a retained distal ventriculoperitoneal (VP) catheter with air tracking from the catheter to the upper chest wall. Given the high suspicion of the catheter being intraluminal, an exploratory laparotomy was performed and revealed multiple jejunal perforations. The patient required a partial small-bowel resection and reanastomosis for complete removal of the retained catheter. Six other similar cases of bowel perforation occurring in patients with abandoned VP and subdural-peritoneal shunts have been reported. The authors analyzed these cases with regard to age of presentation, symptomatic presentation, management, morbidity, and mortality. While there was 0% mortality associated with bowel perforation secondary to a retained distal VP catheter, the morbidity was significantly high and included peritonitis and small bowel resection.
authors.affiliation: Rutgers New Jersey Medical School and.
authors.forename: Gerald J
authors.initials: GJ
authors.lastname: Riccardello
authors.affiliation: Department of Neurology, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Luke K
authors.initials: LK
authors.lastname: Barr
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
authors.forename: Luigi
authors.initials: L
authors.lastname: Bassani
mesh_terms: D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000293:Adolescent; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003937:Diagnosis, Differential; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008591:Meningomyelocele / Q000601:surgery; D013352:Subcutaneous Emphysema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects* / Q000295:instrumentation
keywords: VP = ventriculoperitoneal; abandoned shunt catheter; bowel perforation; hydrocephalus; redundant shunt catheter; retained shunt catheter; ventriculoperitoneal shunt