Management of ventriculo-gallbladder shunt in the presence of gallstones

Abstract

Hydrocephalus is a prevalent health problem that is frequently encountered by paediatric neurosurgeons during infancy and childhood. We report a case of an 11-year-old boy with high cerebrospinal fluid protein hydrocephalus secondary to optic glioma that required a ventriculoperitoneal (VP) shunt. The patient had multiple failures of VP shunt and developed massive ascites. Alternatively, the hydrocephalus was treated by ventriculo-gallbladder (VG) shunt in the presence of sludge which was removed from the gallbladder before placement of the shunt. After VG shunt insertion, the patient expressed signs of infection with elevated liver profile, which emphasised the presence of gallstones. While the shunt was kept in its place without any complications, the gallstones were successfully removed by an endoscopic retrograde cholangiopancreatography. In conclusion, the presence of sludge is not a contraindication for VG shunt placement, and, if the VG shunt was complicated with gallstones, it could be treated without the need for cholecystectomy.

Can we consider ventriculo-gallbladder shunt a first-line treatment in selected patients? Case report of a successful management

“…Commonly in these cases surgeons use the gallbladder to drain CSF as last resort, electing the atrium or the pleural cavity for second viable receptacle. This disinclination to VGS is not counselled by standard guidelines, but mainly as consequence of potential complications (table 2) and technical concerns [3,4,6,7,9,12,12,14,21,23,24]. From our perspective, VGS placement technique, as detailed by Morosanu et al [14], was little different compared to VPS.…”

Ventriculogallbladder Shunt: Percutaneous Transhepatic Placement of the Distal Catheter

“…Contraindications to VGB shunts include previous cholecystectomy, cholecystitis, and cholelithiasis conditions that increase the risk of cholelithiasis, including sickle cell anemia and hereditary spherocytosis, and hepatic or pancreatic disease processes. 3,4 The most commonly used surgical technique for the placement of a distal catheter into the gallbladder is a demanding procedure performed by a general surgeon through a subcostal incision to gain an access to the dome of the gallbladder. 5,6 Approximately 5 cm of the catheter is placed into the gallbladder through an incision in the dome of gallbladder, and a purse string nonabsorbable suture is used to secure the catheter to the gallbladder.…”

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

“…Eventually, the patient developed jaundice and was diagnosed with cholecystitis and cholangitis. The case was managed by performing an ERCP with sphincterotomy and stone extraction without cholecystectomy or shunt removal, and the child was complication-free at 12 months of follow-up [4]. This is in contrast with James et al who resorted to shunt removal [32].…”

“…In addition, Pancucci et al performed a laparoscopic VCS as the first line of treatment in a patient with OCHA and his results were promising, as no complication was demonstrated at 14 months of follow-up [49]. Alraee et al also described a laparoscopic approach to place a VCS in a patient with an extensive optic glioma, which eventually developed gallbladder stones [4].…”

“…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].…”