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

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.
Source: Annals of Pediatric Surgery - Category: Surgery Tags: Case Reports Source Type: research