Introduction
Hydrocephalus, either congenital or acquired, has long been known to
surgeons and many different treatment approaches have been proposed (1).
hydrocephalus happening after a traumatic brain injury has also been
studied in multiple studies. Traumatic brain injury is a leading cause
of death worldwide, especially in low and middle-income countries and
its prevalence is considerable. One of the popular ways of treatment to
decrease intracranial pressure after a brain injury or hemorrhage, is a
surgery known as Decompressing Craniotomy (DC) which itself may be a
major risk factor in occurrence of post traumatic hydrocephalus (2).
Placing an intracranial shunt, may be a reasonable approach to decrease
the complications of hydrocephalus and it can be done either
simultaneous to cranioplasty or not (2). Ventriculoperitoneal shunts
were first proposed by Kausch in 1905 and has been used since (1).
Similar to any other procedure, there are different complications to
this surgery. Abdominal complications, including peritoneal pseudocysts,
intestinal volvulus, protruding in hernial sac or extrusion through
vagina, scrotum, umbilicus or gastrointestinal tract, are rare but
according to previous studies happen in 5-47 % of cases (3-5).
Bowel perforation Is a rare complication and can happen in 0.01 to
0.07% fo patients. It’s also worth mentioning that only 25 percent of
patients with bowel perforation experience the classic clinical symptoms
of peritonitis or bowel perforation. This particular complication should
not be overlooked since it can cause a high mortality rate of 15% (4,
6, 7).
There has been other case reports on this subject, presenting cases
suffering bowel perforation and anal extrusion of the
ventriculoperitoneal shunt (VPS) (8, 9). These cases have been mostly
reported in children.
Here we present a case of transanal protrusion of vps shunt, in an adult
who has undergone surgery after a traumatic brain injury.