Colonic perforation by ventriculoperitoneal shunts.

Two cases of colonic perforation by a ventriculoperitoneal shunt are presented. One was diagnosed by routine abdominal roentgenograms, the other by instilling metrizamide into the distal shunt tubing. A review of the 32 previously reported cases revealed a mortality of 15%. Bowel perforation from a ventriculoperitoneal shunt should be managed with intravenous antibiotics as well as removal of the shunt. If the patient has a benign abdominal examination and no prior history of abdominal complications from a ventriculoperitoneal shunt then the abdominal catheter can be removed percutaneously. However, in the presence of severe peritonitis, or a previous history of serious abdominal problems from the shunt catheter, such as an infected pseudocyst or other intraabdominal pathology, such as active regional enteritis or an abscess, we recommend laparotomy for removing the catheter with primary closure of the bowel perforation.