Ventriculoperitoneal (VP) shunt placement is commonly performed to treat
hydrocephalus and complications are not uncommon. We report here a case of generalized
peritonitis caused by migration of the abdominal end of a VP shunt
catheter into the bowel after multiple VP shunt revisions over 30 years. Laparoscopic surgery was successfully performed for the
peritonitis and the VP shunt system subsequently reconstructed without complications.
CASE PRESENTATION: The patient was a 49-year-old woman who had a VP shunt placed for
obstructive hydrocephalus at the age of 13 years. The shunt system required seven revisions because of various malfunctions, including two occasions where a nonfunctioning shunt
catheter was left inside the abdomen for safety reasons. Approximately 1 year after the seventh revision, she developed
abdominal pain and
fever. Abdominal computed tomography suggested that the shunt
catheter had migrated into the small intestine and caused an
intra-abdominal abscess. We performed emergency exploratory laparoscopy, which revealed perforation of the small intestine by the tip of a nonfunctioning shunt
catheter. A growing
abscess was found around the perforated intestinal wall, causing bacterial
ascites. After the functioning shunt
catheter was pulled out from the abdomen, the nonfunctioning
catheter that had perforated the intestinal wall was removed. The functioning shunt
catheter was then connected to the
cerebrospinal fluid drainage system to manage her severe
hydrocephalus. Finally, the contaminated abdominal cavity was copiously irrigated with
saline solution and a peritoneal drain placed. Twenty-five days later, she underwent another VP shunt surgery in which a VP shunt
catheter was placed. She was discharged 45 days after the surgery for
peritonitis without complications.
CONCLUSION: In cases of
peritonitis with a history of VP shunt placement, perforation by a VP shunt
catheter is possible, though rare. A delay in treatment could lead to a potentially fatal complication, such as
septic shock. Laparoscopic surgery enabled a faster, more hygienic, and minimally invasive operation for managing this rare but serious complication of VP shunt placement.