Delayed intra-abdominal complications of ventriculoperitoneal shunts

Abstract

Acute perioperative abdominal complications of ventriculoperitoneal shunt placement are generally well understood and managed by general surgeons. Delayed complications occur at nontrivial rates and can masquerade as a variety of typical diagnoses such as adhesive bowel obstruction. In some rare cases, the presentation is quite unusual with the shunt protruding from the anus or urethral meatus. Preexisting neurologic conditions often make the history and examination less reliable. Diagnostic and treatment delay can have devastating effects. The variability of these delayed presentations and problems does not allow for evaluation protocols, and the care of these patients must be individualized. General surgery principles continue to apply and, combined with a high index of suspicion, will lead the surgeon to the appropriate diagnosis and treatment options. The barrier is a failure to consider the shunt as the source of the problem when its placement was not recent. A review of the literature and presentation of an unusual case highlight several of the common delayed presentations, diagnoses, and management options. The following core competencies are addressed in this article: Patient Care, Medical Knowledge, System-based Practice.