Endoscopy 2007; 39: E85
DOI: 10.1055/s-2006-945178
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

An unusual foreign body in the transverse colon

F. L. Dumoulin1 , H.-E. Schlief1
  • 1Department of Medicine II, Gastroenterology and Oncology, St. Agnes Hospital Bocholt, Bocholt, Germany
Further Information

F. L. Dumoulin, MD

Department of Medicine II - Gastroenterology and Oncology

St. Agnes Hospital Bocholt

Barloer Weg 125

D-46397 Bocholt

Germany

Fax: +49-2871-202953

Email: f.dumoulin@st-agnes-bocholt.de

Publication History

Publication Date:
18 April 2007 (online)

Table of Contents

A 77-year old man was admitted to our department with fever, headache, abdominal pain, and altered consciousness. He had a history of arterial hypertension, intermittent atrial fibrillation, and dementia, and he had had a ventriculoperitoneal shunt inserted for the treatment of a colloid cyst of the third ventricle. Investigations revealed that he had meningitis. In addition, colonoscopy was performed to investigate his abdominal pain and coprostasis. At this examination we made an unexpected discovery when a piece of tubing - most probably the distal limb of the ventriculoperitoneal shunt - was identified in the transverse colon (Figure [1]), as was the site of perforation (Figure [2]). A free colonic perforation, however, was ruled out by computed tomography. The patient was referred to the neurosurgeons, who performed a ventriculoperitoneal shunt explantation with temporary external ventricular drainage, and he continued on antibiotic treatment. He was discharged in good condition, without further ventricular drainage, after a hospital stay of 15 days.

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Figure 1 A piece of tubing was discovered in the transverse colon at colonoscopy.

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Figure 2 Endoscopic view of the site of the perforation.

The reported incidence of bowel perforation by ventriculoperitoneal shunts is 0.7 % - 0.1 %. This complication usually results in the development of meningitis or brain abscess [1] [2]. In contrast, only 25 % of these patients present with signs of peritonitis or, even more rarely, with per rectal extrusion of the catheter [3] [4] [5].

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Acknowledgment

This article is dedicated to Professor Tilman Sauerbruch, of the Department of Medicine I, University of Bonn, Germany, on the occasion of his 60th birthday.

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References

F. L. Dumoulin, MD

Department of Medicine II - Gastroenterology and Oncology

St. Agnes Hospital Bocholt

Barloer Weg 125

D-46397 Bocholt

Germany

Fax: +49-2871-202953

Email: f.dumoulin@st-agnes-bocholt.de

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References

F. L. Dumoulin, MD

Department of Medicine II - Gastroenterology and Oncology

St. Agnes Hospital Bocholt

Barloer Weg 125

D-46397 Bocholt

Germany

Fax: +49-2871-202953

Email: f.dumoulin@st-agnes-bocholt.de

Zoom Image

Figure 1 A piece of tubing was discovered in the transverse colon at colonoscopy.

Zoom Image

Figure 2 Endoscopic view of the site of the perforation.