Abstract
Background: Dislocation of ventriculoperitoneal (VP) shunt catheters is a well known complication
after treatment of cerebrospinal fluid disorders; however, secondary perforation of
the liver capsule by the catheter is exceptional. The literature on VP shunt complications
involving the liver, their possible pathomechanisms and minimally invasive recovery
strategies in reference to our own experience is reviewed.
Case Report: We present a patient who suffered penetration of the liver by the peritoneal catheter
of her VP shunt. Causing intermittent epigastric pain, the shunt tip was found to
have progressively dislocated into the liver, as documented by CT scans. A laparoscopic
approach was indicated to recover the shunt. The peritoneal catheter was found to
be covered by widespread adhesions, consistent with peritoneal fibrosis. After local
adhesiolysis, it was successfully recovered without shunt dysfunction, hemorrhage
of the liver, or biliary fistula. After 4 months, dislocation recurred with formation
of a subdiaphragmatic pseudocapsule. Early formation of fibrosis was detected during
laparoscopic revision surgery. Although bacterial smears from both laparoscopic surgeries
did not show any pathological findings, the patient presented with an abscess in the
Douglas pouch 4 months later. Coagulase-negative staphylococci were found on ultrasound-guided
insertion of a pigtail catheter. The VP shunt had to be replaced by a ventriculoatrial
shunt. The infection was treated successfully with piperacillin. The subsequent 6
months follow-up period was without adverse events.
Conclusion: The treatment of choice in this exceptional case of intrahepatic shunt dislocation
was laparoscopic recovery of the catheter. Laparoscopy allowed good visualization
during adhesiolysis, immediate exclusion of hemorrhage or bile fistula at the puncture
site, as well as function control and safe deposition of the shunt tip. Chronic infection
as an underlying cause of peritoneal fibrosis has to be ruled out.
Key words
ventriculoperitoneal shunt - endoscopy - hydrocephalus - complications
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Correspondence
S. Berkmann
Department of Neurosurgery
Kantonsspital Aarau
Tellstrasse
5001 Aarau
Switzerland
Phone: +41/62/838 4141
Fax: +41/62/838 6629
Email: sven.berkmann@bluewin.ch
