home : about us : ahead of print : current issue : archives search instructions : subscriptionLogin 
Users online: 718      Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
CASE REPORT
Year : 2007  |  Volume : 2  |  Issue : 1  |  Page : 16-17
 

Intrahepatic abscess complicating ventriculoperitoneal shunt


Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Ashok K Mahapatra
Room No. 720, Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi - 110 029
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.32000

Rights and Permissions

 

   Abstract 

Pyogenic liver abscess occurring as a complication of ventriculoperitoneal shunt is of rare occurrence. The authors report an unusual occurrence of a pyogenic liver abscess in a 10-year-old child complicating the insertion of a ventriculoperitoneal shunt. It was successfully treated by intravenous antibiotics following shunt removal.


Keywords: Complication, liver abscess, ventriculoperitoneal shunt


How to cite this article:
Borkar SA, Kasliwal MK, Mahapatra AK. Intrahepatic abscess complicating ventriculoperitoneal shunt. J Pediatr Neurosci 2007;2:16-7

How to cite this URL:
Borkar SA, Kasliwal MK, Mahapatra AK. Intrahepatic abscess complicating ventriculoperitoneal shunt. J Pediatr Neurosci [serial online] 2007 [cited 2019 Jul 22];2:16-7. Available from: http://www.pediatricneurosciences.com/text.asp?2007/2/1/16/32000



   Introduction Top


Ventriculoperitoneal (VP) shunt is one of the most commonly performed surgeries by neurosurgeons in the management of hydrocephalus. A wide range of complications is reported following the insertion of VP shunt, both neurological and non-neurological. Various abdominal complications are reported with ventriculoperitoneal shunt, most common being shunt blockage due to obstruction of distal end of peritoneal catheter by omentum or other structures. [1] Other complications include formation of abdominal pseudocyst, inguinal hernia, spontaneous bowel perforation and intestinal obstruction. [1],[2],[3],[4],[5],[6] Liver abscess as a complication of VP shunt is rather rare and to the best of our knowledge, only eight such cases have been reported in the literature. [4],[7],[8],[9],[10],[11],[12],[13] The authors report a case of liver abscess following VP shunt insertion in a 10-year-old child successfully managed with shunt removal and intravenous antibiotics.


   Case Report Top


A 10-year-old child presented to the emergency department with complaints of high-grade fever and right upper quadrant abdominal pain 20 days after insertion of a VP shunt. Ultrasound of the abdomen showed a well-defined hypoechoic lesion of size approximately 4 cm x 3 cm in the right lobe of liver, suggestive of a liver abscess. Contrast-enhanced CT abdomen confirmed these findings, showing a 3.8 cm x 2.8 cm size well-encapsulated space occupying lesion (SOL) in the subdiaphragmatic region of the right lobe of the liver with peripheral contrast enhancement [Figure - 1]a and b. A hyperdense focus was seen in the SOL, suggestive of VP shunt tube in view of the history of prior shunt surgery [Figure - 1]a and b. The VP shunt was removed and the patient was started on intravenous piperacillin-tazobactum and metronidazole antibiotics. The fever and pain responded within 48 h, and the IV antibiotics were continued for 3 weeks. Ultrasound abdomen performed at the end of 3 weeks showed resolution of abscess. The patient remained afebrile and is currently doing well.


   Discussion Top


VP shunt is the most commonly performed procedure for the management of hydrocephalus. A number of complications can occur with VP shunts anywhere along the tract from the proximal ventricular end to the distal abdominal end. A wide variety of abdominal complications have been described with VP shunt, the incidence ranging from 5-25%. [1],[8],[9] Mechanical obstruction of the distal catheter, infection, abdominal pseudo cyst, hollow viscus perforation, obstruction and inguinal hernia are the various abdominal complications reported with VP shunts. [1],[2],[3],[4],[5],[6] Migration of distal end to unusual sites such as scrotum and heart is also described in the literature. [14],[15] Intrahepatic migration of distal end of shunt catheter causing liver abscess is rather rare. Postulated pathogenetic mechanism for the development of liver abscess involves direct erosion of the liver by the shunt tube with translocation of gut flora along with tube and can occur any time after the performance of the VP shunt. [4],[8] Direct erosion of liver by VP shunt tube was the most likely mechanism in our patient. Treatment of liver abscess following VP shunt involves immediate removal of the shunt catheter with aggressive antibiotic therapy along with transhepatic drainage of abscess, if needed. Our patient responded favorably to shunt removal with intravenous antibiotic therapy without the need of therapeutic drainage procedure, as also reported by Peterfy and Atri [11] and Tuoho et al . [13]

In short, abdominal complications can herald their presence at any time after the insertion of VP shunt. A high index of suspicion for liver abscess as a potential complication of VP shunt, use of imaging studies to diagnose it early, aggressive antibiotic therapy with shunt removal and transhepatic abscess drainage if needed are the current approaches to manage this rare condition.

 
   References Top

1.Agha FP, Amendola MA, Shirazi KK, Amendola BE, Chandler WF. Abdominal complications of ventriculoperitoneal shunts with emphasis on the role of imaging methods. Surg Gynecol Obstet 1983;156:473-8.   Back to cited text no. 1  [PUBMED]  
2.Burchianti M, Cantini R. Peritoneal cerebrospinal fluid pseudocysts: A complication of ventriculoperitoneal shunts. Childs Nervous System 1988;4:286-90.  Back to cited text no. 2  [PUBMED]  
3.Celik A, Ergun O, Arda MS, Yurtseven T, Ersahin Y, Balik E. The incidence of inguinal complications after ventriculoperitoneal shunt for hydrocephalus. Childs Nerv Syst 2005;21:44-7.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Farrel RJ, Krige JE, Beningfield SJ, Terblanche J. Pyogenic liver abscess following infection of a ventriculoperitoneal shunt. Am J Gastroenterol 1994;89:140.  Back to cited text no. 4    
5.Hlavin ML, Mapstone TB, Gauderer MW. Small bowel obstruction secondary to incomplete removal of a ventriculoperitoneal shunt: Case report. Neurosurgery 1990;26:526-8.  Back to cited text no. 5  [PUBMED]  
6.Snow RB, Lavyne MH, Fraser RA. Colonic perforation by ventriculopeitoneal shunts. Surg Neurol 1986;25:173-7.  Back to cited text no. 6  [PUBMED]  
7.Fisher RA, Rodeziewicz G, Selman WR, White RJ, Vibhakar SD. Liver abscess: Complication of a ventriculoperitoneal shunt. Neurosurgery 1984;14:480-2.  Back to cited text no. 7    
8.Huang LT, Chen CC, Shin TY, Ko SF, Lui CC. Pyogenic liver abscess complicating a ventricular peritoneal shunt. Pediatr Surg Int 1998;13:6-7.   Back to cited text no. 8    
9.Kohno K, Kagawa Y, Takeda S. Liver abscess secondary to ventriculoperitoneal shunt. No Shinkei Geka 1987;15:575-9.  Back to cited text no. 9  [PUBMED]  
10.Paone RF, Mercer LC. Hepatic abscess caused by a ventriculoperitoneal shunt. Pediatr Infect Dis J 1991;10:338-9.  Back to cited text no. 10  [PUBMED]  
11.Peterfy OG, Atri M. Intrahepatic abscess: A rare complication of ventriculoperitoneal shunt. AJR 1990;155:894-5.  Back to cited text no. 11    
12.Reddy SC. Subcapsular hepatic abscess: A rare complication of ventriculoperitoneal shunt. South Med J 1987;80:1309-11.  Back to cited text no. 12  [PUBMED]  
13.Touho H, Nakauchi M, Tasawa T, Nakagawa J, Karasawa J. Intrahepatic migration of a peritoneal shunt catheter: Case report. Neurosurgery 1987;21:258-9.  Back to cited text no. 13  [PUBMED]  
14.Bristow DL, Buntain WL, James HL. Ventriculoperitoneal (VP) shunt migration causing an acute scrotum: A case report of Doppler evaluation. J Pediatr Surg 1978;13:538-9.  Back to cited text no. 14  [PUBMED]  [FULLTEXT]
15.Frazier JL, Wang PP, Patel SH, Benson JE, Cameron DE, Hoon AH Jr, et al . Unusual migration of the distal catheter of a ventriculoperitoneal shunt into the heart: Case report. Neurosurgery 2002;51:819-22.  Back to cited text no. 15  [PUBMED]  [FULLTEXT]


    Figures

  [Figure - 1]


This article has been cited by
1 Multiple Liver Abscesses Associated with Ventriculoperitoneal Shunt Infection: Case Report and Review of the Literature
Tae Ki Yang,Ki-Bum Sim
Journal of Korean Neurosurgical Society. 2013; 54(5): 441
[Pubmed] | [DOI]
2 Combating complications following ventriculoperitoneal shunting in a new centre
Emejulu, J.K.C., Ugwu, J.O.
Pediatric Neurosurgery. 2010; 45(6): 446-450
[Pubmed]
3 Acute cholecystitis complicating ventriculo-peritoneal shunting: Report of a case and review of the literature
Martínez-Lage, J.F., Girón Vallejo, O., López López-Guerrero, A., Martiínez-Lage Azorín, L., Roqués, J.L., Almagro, M.J.
Childęs Nervous System. 2008; 24(6): 777-779
[Pubmed]



 

Top
Print this article  Email this article
Previous article Next article

    

 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (67 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Case Report
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed7607    
    Printed198    
    Emailed3    
    PDF Downloaded329    
    Comments [Add]    
    Cited by others 3    

Recommend this journal