Yala K. Reddy, MD, Shilpa Lingala, MD, Nazneen Ahmed, MD
University of Tennessee Health Science Center, Memphis, TN
Introduction: Complications of ventriculoperitoneal (VP) shunting includes shunt migration, meningitis, peritonitis and peritoneal pseudocyst. Bowel perforation following VP shunt placement is rare, occurring in about 0.01 to 0.03% with the colon being the most common site. We report a case of migration of a VP shunt catheter into the stomach, in a patient who presented with iron deficiency anemia.
Case Description/Methods: A 65-year-old African-American woman was referred to gastroenterology clinic for iron deficiency anemia. She had no gastrointestinal symptoms and fecal immunochemical test was negative. Colonoscopy was unremarkable. EGD showed no evidence of peptic ulcer disease or any arteriovenous malformation up until the fourth part of duodenum. A foreign body protruding into the gastric fundus [Figure 1] was noted. On review of her PMH, she had a VP shunt procedure in 1995 after clipping of an intracranial aneurysm. CT of abdomen confirmed the presence of the VP shunt in the stomach [Figure 2]. The patient was referred to General Surgery for laparoscopy. During surgery, approximately five-six cm of the distal tip of the VP shunt was intragastric, forming a fistula between the stomach and the abdominal wall. The fistula was sealed, and the shunt was repositioned intraperitoneally. The patient was stable after the surgery.
Discussion: From a review of the literature, our patient’s presentation with iron deficiency anemia and no gastrointestinal symptoms was unusual. Only 16 cases of intragastric migration of a peritoneal catheter have been previously described. Most patients complained of abdominal discomfort prior to the intragastric perforation. This complication predominantly affects children . The mean interval between the last shunt procedure and perforation was approximately 48.3 months (1 day to 23 yrs) and is unpredictable. The possible mechanisms of bowel perforation includes catheter adherence causing a local inflammation resulting in fibrosis or the continuous pressure from the catheter tip leading to erosion of the bowel and delayed perforation. Our patient could also have had chronic gastric bleeding which may have contributed to her iron deficiency anemia. Treatment approaches include injection of fibrin glue to close the perforated stomach wall, and direct suture of the stomach wall by laparotomy. In our patient, the latter approach was taken. To our knowledge, this is the only reported case of a patient with intragastric migration of a VP shunt presenting with iron deficiency anemia.
Citation: Yala K. Reddy, MD, Shilpa Lingala, MD, Nazneen Ahmed, MD. P0426 - VENTRICULOPERITONEAL SHUNT MIGRATION INTO THE STOMACH: CASE REPORT AND REVIEW OF LITERATURE. Program No. P0426. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.