title: Transanal presentation of a distal ventriculoperitoneal shunt catheter: Management of bowel perforation without laparotomy.
abstract: BACKGROUND
  Bowel perforation is a serious but rare complication after a ventriculoperitoneal shunt (VPS) procedure. Prior studies have reported spontaneous bowel perforation after VPS placement in adults of up to 0.07%. Transanal catheter protrusion is a potential presentation of VPS bowel perforation and places a patient at risk for both peritonitis and ventriculitis/meningitis via retrograde migration of bacteria. This delayed complication can be fatal if unrecognized, with a 15% risk of mortality secondary to ventriculitis, peritonitis, or sepsis.
  
  
  METHODS
  We describe a unique case of a patient with distal VPS catheter protrusion from the anus whose bowel perforation did not cause clinical sequelae of infection. We were able to manage the patient without laparotomy.
  
  
  CONCLUSIONS
  A subset of patients can be managed without laparotomy and only with externalization of the ventricular shunt with antibiotics until the cerebrospinal fluid cultures finalize without growth.
authors.affiliation: Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: James
authors.initials: J
authors.lastname: Bales
authors.affiliation: Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Morton
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Nathan
authors.initials: N
authors.lastname: Airhart
authors.affiliation: Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: David
authors.initials: D
authors.lastname: Flum
authors.affiliation: Department of Neurological Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Avellino
keywords: Bowel perforation; complications; ventriculoperitoneal shunt