Unexpected findings during colon cancer surgery: A rare complication of ventriculoperitoneal shunt

BACKGROUND: Complications such as infections and obstructions of the ventriculoperitoneal (VP) shunt are common. However, VP shunt trapped on the serosal side of colon cancer is rare, and there is no clear treatment strategy. CASE DESCRIPTION: A 72-year-old man presented with a 1-month history of constipation, diarrhea, and weight loss. His medical history consisted of subarachnoid hemorrhage and hydrocephalus 13 years earlier, for which endovascular coiling and VP shunting were performed. Colonoscopy showed a sigmoid mass, the biopsy of which revealed tubular adenocarcinoma. Computed tomography demonstrated circumferential wall thickening of the sigmoid colon without evidence of metastasis, with the lesion surrounding the tip of the VP shunt. He underwent laparoscopic surgery for sigmoid colon cancer. Unexpectedly, the VP shunt was trapped in the serous side of the tumor, and both the shunt and tumor were excised. Microscopic examination revealed inflammation and fibrosis, but no cancer cells were found in the serosa surrounding the embedded VP shunt tip. CONCLUSION: Bowel perforation due to a VP shunt is a rare but emergency condition. If the perforation occurs around cancerous tissue, it must be handled with extreme care; excising the shunt along with the tumor may be the safest treatment method. Clinicians need to pay attention to the end of the VP shunt when performing surgery for patients with cancer and VP shunt.