Tube Found in Anus during Defecation: Sigmoid Colon Perforation after Ventriculoperitoneal Shunt Surgery in an Elderly Patient

Bowel perforation with anal protrusion of the ventriculoperitoneal (VP) shunt catheter is a rare complication of VP shunt surgery. Most of the complications reported to date have occurred in children, and there are very few reports of complications in elderly patients. An 80-year-old man with normal pressure hydrocephalus (NPH) was treated by VP shunting by mini-laparotomy; a subsequent abdominal wall infection necessitated additional VP shunting, which was performed using the blind puncture technique. Three months after the second VP shunting, the patient presented with anal protrusion of the shunt catheter. Exploratory laparotomy revealed that the shunt catheter had penetrated the subcutaneous tissue through the mesocolon into the redundant sigmoid colon and formed a colocutaneous fistula. Subsequently, exploratory laparotomy with closure of the colocutaneous fistula, loop colostomy of sigmoid colon, and extrusion of the catheter was performed. Fever or signs of meningeal irritation, and increased intracranial pressure were not noted at the follow-up examination performed 1 month after the procedure. In conclusion, this case suggests that if the patient has a history of intra-abdominal surgery, the surgeon should exercise caution while performing the blind puncture technique for VP shunt surgery since this surgery may result in direct injury to the adhesive bowel.