NEUROSURGICAL IMAGE Jejunal perforation and peroral extrusion of a peritoneal shunt catheter

The incidence of intestinal perforation following a ventriculo-peritoneal shunt (VPS) insertion ranges between 0.1 and 0.7 % of all abdominal complica-tions of this procedure.1 Perforation of the colon constitutes the majority, while those of the stomach and small bowel are rare events. A case of transoral protrusion of a peritoneal shunt catheter that had spontaneously perforated the jejunal wall is de-scribed. The patient was a 15-month-old female infant who presented with oral protrusion of a distal catheter of a Chhabra-slit-in-spring silicone shunt system inserted for hydrocephalus 6 months earlier (Fig. 1). Two weeks before current presentation she developed skin necrosis and infection along the shunt tract behind the right ear, and this exposed the shunt