Disconnected subduroperitoneal shunt catheter induces silent bowel perforation: An unusual complication.

We report a case of silent bowel perforation by a fractured subduroperitoneal shunt after surgical shunt revision. A 93-year-old bedridden man experienced transanal prolapse of a shunt catheter after defecation. Upon arrival, the patient showed no fever or acute abdominal signs. Abdominal computed tomography (CT) showed an abandoned shunt catheter in the lower abdomen with rectum perforation. The disconnected catheter was successfully removed from the anus by digital rectal maneuver, and no peritonitis or other complication developed afterward. Such broken shunts no longer provide drainage function, and also pose a risk of migrating into the hollow viscera. Therefore, even in the absence of overt peritoneal signs, disconnected catheters should be removed by laparoscopic or minimal surgery to prevent possible development of this unusual complication. Instances of the rare complication are reviewed, and pathogenesis and treatment of the condition are discussed.