Department of Surgery, Division of Pediatric Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Department of Surgery, Division of Pediatric Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Childs Nerv Syst. 2021 Aug;37(8):2719-2722. doi: 10.1007/s00381-020-05019-1. Epub 2021 Jan 2.
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.
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.
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.
脑室腹腔（VP）分流术是小儿和成人脑积水的最常见治疗方法。分流术腹部部分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。然而，也可能发生其他较少见的并发症。作者报告了一例具有长期 VP 分流术病史的患者，由于导管管腹段的结扣而导致急性腹痛。
一名 13 岁男性，既往有脊髓脊膜膨出病史，在 18 个月时需要脑室腹腔分流术，因腹痛就诊于外院。横断面成像显示分流管在小肠系膜根部自发形成结扣。随后他被转至我院进行普外科和神经外科评估。他的腹部检查除了压痛、腹肌紧张和反跳痛外，还可见弥漫性腹胀。鉴于他的病情不稳定和腹膜炎，他紧急接受了腹部探查。他接受了肠切除术，将分流管外置，然后进行再吻合和分流管内置。他最终完全康复。
鉴于这种情况和其他与分流术相关的并发症可能导致大量肠段丢失，因此，即使是长期的 VP 分流术也应在任何有分流术的患者的腹痛鉴别诊断中考虑。
