Investigation of Suspected VP-Shunt-related pseudocyst reveals Distal Shunt Erosion into Small Bowel

Posted By Kelsey Bourm
Investigation of Suspected VP-Shunt-related pseudocyst reveals Distal Shunt Erosion into Small Bowel

An 8-year-old female born at 29 weeks gestational age with a history of cerebral palsy and three prior VP shunt revisions presents with a 2-day history of nonbilious, fever, and cephalgia. CT Head on admission demonstrated ventriculomegaly. A subsequent nuclear medicine shuntogram verified patency of the distal shunt tubing, however, there was a central organization of radiotracer in the abdomen in a pattern commonly seen with pseudocyst formation. The follow-up CT of the abdomen and pelvis revealed that the shunt tubing was now intraluminal within several small bowel loops. This CT finding was subsequently verified during an exploratory laparotomy. The VP shunt fluid analysis revealed gram-negative bacteria. Bowel perforation is a rare complication of VP shunt placement. When seen, it most commonly affects the large bowel and stomach. We thus report the exceedingly uncommon instance of small bowel perforation by a VP shunt catheter. This case also highlights a differential consideration for central organization of intra-abdominal radiotracer when seen on a nuclear medicine shuntogram.

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