Clin Endosc.  2022 Jan;55(1):146-149. 10.5946/ce.2020.293.

Intestinal Perforation Caused by Lumboperitoneal Shunt Insertion Repaired with an Over-the-Scope Clip

• Ishizuka N
• Komatsu E

• KMID: 2525062
• DOI: http://doi.org/10.5946/ce.2020.293

Abstract

Lumboperitoneal or ventriculoperitoneal shunt insertion is a standard therapy for hydrocephalus that diverts cerebrospinal fluid from the subarachnoid space into the peritoneal cavity. Gastrointestinal perforations due to this procedure occur rarely; however, accepted treatment strategies have not yet been established. Hence, the most common treatment approaches are open surgery or spontaneous closure without endoscopy. We report the case of a small intestinal perforation in a 73-year-old-woman that occurred after the insertion of a lumboperitoneal shunt. A positive cerebrospinal fluid culture and high cerebrospinal fluid white blood cell count indicated a retrograde bacterial infection, and computed tomography revealed that the peritoneal tip of the shunt catheter was located in the lumen of the gastrointestinal tract. We repaired the perforation endoscopically using an over-the-scope clip, and the patient’s recovery was uneventful. Use of an over-the-scope clip could be an effective and minimally invasive treatment for intestinal perforations caused by lumboperitoneal or ventriculoperitoneal shunt insertion.

Keyword

Bacterial infection; Hydrocephalus; Intestinal perforation; Laparotomy; Ventriculoperitoneal shunt

Figure

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  Fig. 1. Abdominal/pelvic computed tomography on admission showing the shunt catheter penetrating the abdominal wall and its location in the gastrointestinal tract. (A) Entry of the lumboperitoneal shunt catheter into the abdominal cavity from the lower left abdomen. (B-D) Location of the shunt catheter in the intestinal tract (arrows indicate the shunt catheter).

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  Fig. 2. Endoscopic images taken before and after repairing the perforation site with an over-the-scope-clip (OTSC). (A) The shunt catheter is penetrating the ileal wall and is located within the intestinal tract. (B) The perforation site is closed using an OTSC.

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  Fig. 3. Abdominal radiographs acquired after the use of an over-the-scope-clip (OTSC) (arrows indicate the OTSC). (A) Confirming the closure of the perforation by administering a gastrografin infusion through the endoscope. (B) Plain abdominal radiography showing successful OTSC use.

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