Unusual complications can result from the use of familiar devices. The following case
highlights one such instance.
A 33-year-old nurse was admitted to our hospital with a 1-month history of abdominal
pain, vomiting and headache. Previously she had had a ventriculoperitoneal shunt of
unspecified type inserted for congenital hydrocephalus.
Clinical examination on admission showed her to be afebrile with a soft and nontender
abdomen. Bowel sounds were normal. Neurological examination revealed no specific abnormality
and fundoscopy was normal.
Laboratory investigation showed haematological and biochemical measurements to all
be unremarkable. Plain abdominal radiography identified the ventriculoperitoneal shunt
in the left hypochondrium but abdominal ultrasound and computed tomography scan revealed
no abnormality.
Oesophagogastroduodenoscopy revealed the cause of the abdominal pain. The peritoneal
catheter had perforated the anterior wall of the stomach and was seen lying over the
greater curve where a small pool of cerebrospinal fluid was identified (Figure [1]). The shunt was repositioned laparoscopically, and the patient's symptoms settled.
Figure 1 An endo-scopic image showing the distal end of a ventriculoperitoneal shunt perforating
the anterior wall of the stomach and discharging a small pool of cerebrospinal fluid
onto the greater curve
A review of the literature revealed two previous cases of gastric perforation by peritoneal
shunt [1]
[2]
. This is therefore an unusual situation but should be considered in any patient known
to have a ventriculoperitoneal shunt who develops recurrent attacks of abdominal pain.
Acknowledgements
We wish to thank the two surgeons involved in this case, Mr G. A. Ponting and Mr J.
A. Kellerman, and to thank Marilyn Lucas for typing the manuscript.
