Julia Stephens* and Jack Neppl
Introduction: Ventriculoperitoneal (VP) placement is the most common procedure performed by neurosurgeons with a high range of reported complication rates with a mean complication rate of 23.8%. Such complications included shunt failure, infection, shunt migration, pneumocephalus, and subdural hematoma. A small portion of the catheter migrations can lead to abdominal pain by penetrating walls of the viscera or the peritoneal wall. Because 15% of these cases result in death, recognizing and treating this complication quickly is essential.
Case presentation: A 56-year-old Caucasian male with a history of hydrocephalus treated with multiple VP shunt placements presented to the ED in a community setting three times over the course of two months with RLQ pain.
Clinical course: The patient continued to have severe abdominal pain despite multiple visits to the ED and an inpatient stay for treatment of suspected colitis. Referral to general surgery allowed for definitive diagnosis where a diagnostic colonoscopy showed the distal portion of a VP shunt was penetrating the wall of the cecum. Subsequent laparoscopy was performed to remove multiple disconnected VP shunts with closure of the cecotomy with two endoclips, which resulted in rapid improvement of the patient’s pain.
Conclusion: When considering the differential diagnosis for abdominal pain in a patient with a VP shunt, it is necessary to recognize distal shunt migration as an uncommon but serious cause of the pain. Bowel perforation is a complication of VP shunt placement that occurs in 0.1-0.7% of patients, with 15% of these resulting in death.
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