Presentation
Acute abdomen with fever, severe headaches, and elevated CRP. History of VP shunting for posttraumatic hydrocephalus.
Patient Data
Age: 25 years
Gender: Male
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The CT scan demonstrates:
- free fluid in the peritoneal cavity
- thickening with enhancement of the peritoneal reflections
- moderate thickening with enhancement of the bowel loops mainly the ileum and right colon
- small fluid collection is noted adjacent to the cecum
- the ventriculoperitoneal shunt catheter is coiled around the bowel loops with no evidence of intestinal obstruction
- small reactive mesenteric lymphadenopathies are noted
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- right parietal VP shunt with the tip in the body of the right lateral ventricle
- dilatation of the ventricular system (3rd, 4th, and lateral ventricles) with complete effacement of the cerebral sulci, Sylvian fissures and basal cisterns, in keeping with a hydrocephalus
- periventricular low attenuation in keeping with transependymal edema.
- no enhancement of the ventricular wall
- left frontal craniotomy with sequelae of frontal sinus fracture
Case Discussion
Nice case showing two complications of a VP shunt:
- shunt infection with peritonitis
- hydrocephalus by blockage of the distal tip
The most common distal (or intra-abdominal) complications of the VP shunt are shunt infection and obstruction. Others complications may be seen such as mechanical blockage, intestinal obstruction, peritoneal pseudocysts, and hydrocele 1,2.
Additional contributor: ZE. Boudiaf, MD
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