Gastrointestinal: Abdominal abscess associated with a ventriculoperitoneal shunt
Journal
Journal of Gastroenterology and Hepatology (Australia)
Journal Volume
22
Journal Issue
5
Pages
757
Date Issued
2007
Author(s)
Abstract
Tubes can sometimes be used to move fluid into or out of the peritoneal cavity. One example is the LeVeen shunt for intractable ascites. This moves fluid from the peritoneal cavity into a central vein, usually the junction of the superior vena cava with the right atrium. These shunts are now rarely used because of a variety of complications including disseminated intravascular coagulation, variceal hemorrhage, infection, cardiac failure and venous thrombosis. Furthermore, a randomized trial showed that LeVeen shunts did not improve survival in patients with severe ascites associated with alcoholic cirrhosis. Shunts can also be used in hydrocephalus or low-pressure hydrocephalus to divert cerebrospinal fluid. The distal end of the shunt can be placed in the right atrium or in the peritoneal or pleural cavity. In those patients with shunts in the peritoneal cavity, abdominal complications are uncommon but include ascites, peritonitis, abscesses and pseudocysts containing cerebrospinal fluid. Clinical features of a shunt abscess include fever and abdominal pain. The diagnosis is usually made by an abdominal ultrasound study or by an abdominal computed tomography scan (CT). Treatment consists of intravenous antibiotics, removal of the shunt from the peritoneal cavity and conversion of the shunt to external drainage. The images shown below are from a 76-year-old man who was treated with a ventriculoperitoneal shunt for normal-pressure hydrocephalus in 2003. The shunt was revised in 2004 because of suspected shunt dysfunction. Six months later, he developed abdominal pain and fever that was associated with an elevated white cell count. An ultrasound study showed fluid collections in the left abdomen and the reformatted, enhanced CT scan revealed a well-defined lobulated fluid collection in the left abdomen (Fig. 1). The tip of the shunt catheter was outlined within the collection (arrow). The course of the shunt catheter was traced on the maximum intensity projection shown in Fig. 2 (arrow). The diagnosis of a shunt-related abscess was confirmed by the percutaneous aspiration of pus. Cultures revealed a methicillin-resistant Staphylococcus aureus, Proteus mirabilis and Staphylococcus epidermidis. Symptoms resolved after use of intravenous antibiotics and removal of the shunt from the peritoneal cavity.
SDGs
Other Subjects
antibiotic agent; antiinfective agent; abdominal abscess; abdominal pain; aged; article; aspiration; bacterium culture; brain ventricle peritoneum shunt; case report; device removal; disease association; erythrocyte count; fever; human; male; methicillin resistant Staphylococcus aureus; normotensive hydrocephalus; priority journal; Proteus mirabilis; Staphylococcus epidermidis; abdominal abscess; brain ventricle peritoneum shunt; computer assisted tomography; instrumentation; isolation and purification; microbiology; normotensive hydrocephalus; radiography; Staphylococcus aureus; treatment outcome; Abdominal Abscess; Aged; Anti-Bacterial Agents; Device Removal; Humans; Hydrocephalus, Normal Pressure; Male; Proteus mirabilis; Staphylococcus aureus; Staphylococcus epidermidis; Tomography, X-Ray Computed; Treatment Outcome; Ventriculoperitoneal Shunt
Publisher
Blackwell Publishing
Type
journal article