Laparoscopic Management of Sigmoid Colon Perforation With Transanal Extrusion of a Ventriculoperitoneal Shunt Nine Weeks After Placement: A Case Report.

Bowel perforation with transanal extrusion of a ventriculoperitoneal shunt is a rare and potentially serious complication. We report a 22-month-old boy with spina bifida and hydrocephalus who presented with the distal catheter protruding through the anus nine weeks after shunt placement. Laparoscopy identified a single approximately 10-mm sigmoid colon perforation without abscess, feculent contamination, or macroscopic peritonitis. Under direct visualization, the previous catheter was mobilized into the abdominal cavity and removed transanally through the existing perforation. The defect was closed primarily, followed by peritoneal lavage. Given the absence of gross contamination, neurological manifestations, or initial evidence of cerebrospinal fluid infection, a completely new shunt was placed through a separate tract during the same operation. Cerebrospinal fluid and blood cultures remained negative. The patient resumed enteral feeding on postoperative day 3, was discharged on postoperative day 5, and remained asymptomatic at the three-month follow-up. This case highlights the diagnostic and therapeutic utility of laparoscopy in selected patients.