Background

Ventriculoperitoneal (VP) shunts are the most common treatment for hydrocephalus in both pediatric and adult patients. Complications resulting from the abdominal portion of shunts include tube disconnection, obstruction of the shunt tip, catheter migration, infection, abdominal pseudocysts, and bowel perforation. However, other less common complications can occur. The authors present a unique case of a patient with a longstanding VP shunt presenting with an acute abdomen secondary to knotting of the peritoneal portion of the catheter tubing.

Case description

A 13-year-old male with past medical history significant for myelomeningocele, requiring ventriculoperitoneal shunt placement at 18 months of age, presented to an outside hospital with chief complaint of abdominal pain. Cross-sectional imaging revealed spontaneous knot formation within the shunt tubing around the base of the small bowel mesentery. He was then transferred to our facility for general and neurosurgical evaluation. His abdominal exam was notable for diffuse distension in addition to tenderness to palpation with guarding and rebound. Given his tenuous clinical status and peritonitis, he was emergently booked for abdominal exploration. He underwent bowel resection, externalization of his shunt, with later re-anastomosis and shunt internalization. He eventually made a full recovery.

Discussion

Given the potential for significant bowel loss with this and other shunt-related complications, this case serves as a reminder that even longstanding VP shunts should be considered in the differential diagnosis of abdominal pain in any patient with a shunt.

中文翻译：

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长期脑室腹腔分流导管继发肠系膜绞窄病例报告

背景

脑室腹腔 (VP) 分流术是儿童和成人脑积水最常见的治疗方法。腹部分流导致的并发症包括管断开、分流尖端阻塞、导管迁移、感染、腹部假性囊肿和肠穿孔。但是，可能会出现其他不太常见的并发症。作者介绍了一个独特的病例，该患者长期存在 VP 分流，并出现继发于导管腹膜部分打结的急腹症。

案例说明

一名 13 岁男性，既往有明显的脊髓脊膜膨出病史，需要在 18 个月大时进行脑室腹腔分流术，主诉腹痛，就诊于外部医院。横截面成像显示小肠系膜底部周围的分流管内自发结形成。然后他被转移到我们的设施进行一般和神经外科评估。除了触诊有压痛和反跳外，他的腹部检查还发现了弥漫性腹胀。鉴于他脆弱的临床状况和腹膜炎，他被紧急预约进行腹部探查。他接受了肠切除术，将分流管外化，随后进行了重新吻合和分流内化。他最终完全康复。

讨论

鉴于这种和其他与分流相关的并发症可能导致严重的肠丢失，这个案例提醒我们，即使是长期的 V​​P 分流，在任何分流患者的腹痛鉴别诊断中也应考虑。