Enterocutaneous fistula and internal hernia: unusual complications of peritoneal catheter migration into the ileum in a patient with ventriculoperitoneal shunt

Abstract

The aim of the present study was to report the treatment of an unusual association of ventriculoperitoneal shunt (VPS). Although a commonly performed paediatric neurosurgical procedure, a VPS is associated with several complications. There are reports on gut perforation by the peritoneal catheter, but an enterocutaneous fistula is very rare. Only two have been previously reported in literature. We report, here, the first case seen in Nigeria involving a 3-year old boy, at our teaching hospital setting, with a history of a fall 18 months after VPS; this was followed by purulent, and, later, faeculent discharge from the right subcoastal region and abdominal wound. He underwent detailed neurological examination. Preoperative evaluation with a fistulogram (as a barium meal and follow-through because the superficial opening was not clearly visible to allow direct injection of contrast) showed a connection between the intestine and the skin over the shunt tunnel. He underwent a laparotomy with thorough antiseptic irrigation and repositioning of the VPS in peritoneal cavity. Postoperatively, the faeculent discharge from the upper anterior abdominal wall ceased.  He was discharged home in 2 weeks. There was complete resolution after 6 months. We conclude that there should be a high index of suspicion of an enterocutaneous fistula, although very rare, when faecal discharge is noticed following a VPS and should necessitate a fistulogram. Effective surgical treatment of the intraluminal migration and other possible complications, should involve a multidisciplinary team.

Keywords: complications, enterocutaneous fistula, internal hernia, intraluminal migration, multispecialty treatment, ventriculoperitoneal shunt