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CASE REPORT |
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| Year : 2007 | Volume
: 2
| Issue : 1 | Page : 16-17 |
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Intrahepatic abscess complicating ventriculoperitoneal shunt
Sachin A Borkar, Manish Kumar Kasliwal, Ashok K Mahapatra
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
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1817-1745.32000
 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 |
| Introduction | |  |
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 | | |
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 | | |
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 | | |
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[Figure - 1]
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