Background: Bowel perforation is a rare complication of ventriculoperitoneal (VP) shunt placement that can result in anal protrusion of a VP shunt. Retro-grade migration of bacteria through the shunt can lead to central nervous system (CNS) infections, such as meningitis, most commonly caused by Escherichia coli or other enteric pathogens. Here we present a case of methicillin-resistant Staphylococcus aureus (MRSA) meningitis from transanal migration of a VP shunt. Case Report: A 2-month old female with a history of VP shunt placement presented to the emergency department (ED) after her mother noticed a tube in the patient's diaper. On examination, a white tube was noted to be protruding from the patient's anus. Plain radiographic shunt series showed an intact VP shunt terminating outside of the patient's body. Cerebrospinal fluid (CSF) cultures grew MRSA. A diagnosis of MRSA meningitis secondary to spontaneous bowel perforation of a VP shunt was made. The patient went to the operating room for externalization of her shunt. Why Should an Emergency Physician Be Aware of This?: To our knowledge, this is the first case of MRSA meningitis following transanal migration of a VP shunt to be reported in the literature. While anal protrusion of a VP shunt is rare, CNS infection from this complication results in a high mortality rate. In addition, not all cases of bowel perforation from a VP shunt will present with the shunt exiting the body. Therefore, in a patient with a history of a VP shunt who presents with symptoms of meningitis, it is important for emergency physicians to heavily consider intestinal perforation by VP shunt as a possible etiology. (C) 2019 Elsevier Inc. All rights reserved.
