Small Bowel Obstruction and Enterococcus Meningitis: Rare Complications of Ventriculoperitoneal Shunt Placement

Abstract

A ventriculoperitoneal (VP) shunt is a commonly used mechanical device indicated for congenital and acquired hydrocephalus in children. Although VP shunt failure is not uncommon, the symptomatology and cause of failure can vary. In this case, we describe intestinal obstruction in a three-year-old Caucasian female with a history of Pilomyxoid Astrocytoma and VP shunt placement for the management of hydrocephalus. Surgical exploration revealed ischemia of the terminal ileum secondary to VP shunt tubing-induced adhesions requiring bowel resection. A secondary VP shunt infection due to Enterococcus faecalis was also noted. Our case highlights a unique presentation of intestinal obstruction and infection that should serve to increase provider suspicion when evaluating patients presenting with abdominal distention and pain with presence of a VP shunt.

Keywords: endoscopic third ventriculostomy; gram-positive meningitis; pilomyxoid astrocytoma; small-bowel obstruction; ventriculoperitoneal shunt.

Figure 1. Initial abdominal X-ray revealing nonspecific bowel gas pattern with aerated loops of bowel most consistent with intestinal ileus

Figure 2. Repeat abdominal X-ray revealing persistent evidence of bowel gas paucity and bowel loop distention as identified by blue arrow

Figure 3. Intraoperative photograph showing a visualized area of terminal ileum with adhesive band pinching, as identified by blue arrow, and stricture development