Laparoscopic Cholecystectomy for Acute Calcular Cholecystitis in a Patient with Ventriculoperitoneal Shunt: A Case Report and Literature Review

Abstract

Management of patients who have ventriculoperitoneal shunt presenting with acute calcular cholecystitis has remained a clinical challenge. In this paper, the hospital course and the follow-up of a patient presenting with acute calcular cholecystitis and ventriculoperitoneal shunt managed with laparoscopic cholecystectomy are presented followed by literature review on the management of acute calcular cholecystitis in patients who have ventriculoperitoneal shunts.

Feasibility of laparoscopic cholecystectomy in patients with cerebrospinal fluid shunt

“…To our knowledge, seven prior studies, with detailed case information, have reported laparoscopic cholecystectomy in a total of 10 cases with CSF shunts . Table presents a list of these studies.…”

Laparoscopic Intervention after Ventriculoperitoneal Shunt: A Case Report, Systematic Review, and Recommendations

“…In our analysis, we specifically focused on different approaches and managements in patients with VP shunts needing laparoscopic intervention. 1,2,8,10,17, The age of the patients ranged from 1 to 79 years. The operations were performed by the departments of general surgery, gynecology, and urology.…”

“…The pressure used for the pneumoperitoneum was between 8 mm Hg and 50 mm Hg, mostly 12 mm Hg. 1,2,8,10,17,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]39,40 The following complications occurred: one case of massive subcutaneous emphysema, 11 cases of conversion to laparotomy due to extensive inflammation, gangrenous situation, 10,20 a large tumor, and adhesions. 21,36 One case of shunt failure directly after the operation, 24 eight cases of postoperative VP shunt removal or revision due to infection, 1,2,8,10 one case of multiple organ failure and death, 20 and one case of pneumocephalus.…”

“…There were several cases without any safety precautions being described, 1,8,17,[20][21][22][23][24][25][26]32,34,37,39 but some surgeons used the following protecting techniques: clamping of the shunt intra-abdominally, 19,29,38 clamping of the shunt through a skin incision, 23 externalization of the shunt before insufflation 10,27,30 or intraoperatively because of the possibility of a peritonitis, 31 and packing of the shunt with a simple gauze, so that it is further away from the operative field. 10,27 Two cases were reported with patients who were diagnosed with cancer, where clamping 38 and intraoperative shunt externalization were the methods of choice.…”

“…10,[13][14][15][16] Patients who have VP shunts represent a special group who require special attention. 17 At the time, they have a near to normal life expectancy and are presume to undergo laparoscopic operations as other patients. We are presenting a case of a patient with ascites, a cardiovascular decompensation, and a VP shunt in situ.…”