Health Care : Current Reviews

Anal shunt extrusion in a child

Joint Webinar: 14^th International Conference on Clinical Case Reports & 6^th International Conference on Pediatrics and Healthcare & 10^th World Summit on Oncology and Cancer Science

November 24, 2022 | Webinar

Fisiha Gebeyehu

Bahir Dar University, Ethiopia

Scientific Tracks Abstracts: Health Care Curr Rev

Abstract:

Ventriculoperitoneal shunt (VPS) implantation is a wellaccepted and one of the preferred surgical procedures for the management of hydrocephalus. VPS implantation is associated with a wide variety of complications. Among common complications include infection, obstruction, disconnection, CSF pseudocyst formation and migration. Anal extrusion of a peritoneal catheter is a rare complication ranging from 0.1 to 0.7% of all shunt surgeries. This study presents a rare case of anal extrusion of ventriculoperitoneal shunt in a one year and 7 months old male child who presented with extruding distal peritoneal tip of shunt tube per anus of 48 hours duration and five episode of vomiting of ingested matter. The physical examination did not reveal any signs of peritonitis or meningitis. There is palpable VPS shunt which has functional valve at right temporal area and subcutaneously palpable on right neck and chest area. Peritoneal end of the VP shunt was protruding through the anus. There was dribbling of cerebrospinal fluid (CSF) at the distal end of VP shunt. This study found several contributing factors affecting the complications in the anal extrusion of a peritoneal catheter, that are thin bowel wall in children and sharp tip and stiff end of VP shunt. Shunt series radiograph done and showed no fracture of shunt, but distal peritoneal end of the shunt tube going well beyond the pubic symphysis. There was no knotting of the shunt tube seen. No gas under diaphragm noted. With minimal skin incision at right upper chest and right upper quadrant (just right epigastric).2 cm skin incision at right upper chest (above the nipple). Same 2 cm incision done at previous right subcostal area at which after proximal and distal part of shunt clump then shunt cut. Proximal to the subcostal area shunt exteriorized through the upper chest wound and distal shunt gently removed trans anal after distal end clump by the artery. CSF sample taken from proximal shunt for analysis and urine bag attached to the proximal shunt both wounds closed. This study concludes that due to potentially life-threatening consequences and case rarity, thorough anamnesis, physical examination, and objective investigation are needed to determine the appropriate management for anal extrusion of ventriculoperitoneal shunt. Awareness of this unusual complication among general surgeons and physicians is very important so that early recognition, management, and timely intervention can save the life of the patient. Key words: Hydrocephalus, Transanal Extrusion, Ventriculoâ??Peritoneal Shunt, Shunt Revision, Migration

Biography :

Fisiha Gebeyehu was received his MD at the age of 25 from Bahirdar University and certified specialty certificate in neurosurgery at the age of 32, currently practicing neurosurgery in Tibebe ghion specialized university hospital.