A rare, delayed complication of a ventriculogallbladder shunt

Abstract

<jats:p>✓The use of the gallbladder as an alternative cerebrospinal fluid diversion site has been previously described in cases in which all other body cavities, such as the peritoneal cavity, right atrium, or pleural cavity, have been exhausted. Various ventriculogallbladder (VG) shunt complications have been described as well. In the present paper, the authors report on a rare, delayed VG shunt complication. A distal obstruction developed in a previously inserted VG shunt because of a large, radiolucent bile calculus. The presence of the VG shunt could be implicated in the pathogenetic mechanism of the bile calculus formation. The authors also review the pertinent literature.</jats:p>

Ventriculogallbladder Shunt: Percutaneous Transhepatic Placement of the Distal Catheter

“…This remarkable ability to handle large amounts of fluid makes it an excellent location for redirected excess CSF. 13,15 The gallbladder has an intrinsic pressure of 10 to 20 cmH 2 O compared with 6 to 7 cmH 2 O in the peritoneum and 0 to 4 cmH 2 O 4 in the right atrium. This relatively high pressure in a receptive cavity helps to keep the intracranial pressure of shunted patient within a more physiological range.…”

Percutaneous placement of the peripheral catheter to the subclavian vein for a VA shunt

“…Gallbladder, however, offers an environment where CSF water and electrolytes can be effectively absorbed without being affected from the pressure changes during bladder contractions or predisposing to gall stones formation with the most common complication reported being shunt infection (reaching up to 32% of reported cases). Moreover, bile reflux and chemical ventriculitis have been reported with fatal consequences in one case [ 3 ]. Finally, even without the catheter being the cause, synchronous gallstones presence can cause catheter obstruction and shunt malfunction [ 4 ].…”

Evaluation of the ventriculocholecystic shunt—an overview of present practice in adult and pediatric hydrocephalus

“…Subsequently, the shunt was converted to a VPL shunt. Despite the unfortunate outcome, this case describes the longest period of time in which a VCS was patent [17].…”

“…Obstruction can also be caused by a calculus formation around the distal end of an existing shunt. Fountas describes cholelithiasis in a longstanding shunt that eventually led to it being removed through a cholecystectomy [17], whereas Alraee et al performed the stone extraction through an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, without shunt removal [4]. Surfield and Klein also identify the same issue in an adult patient [67].…”