Ventriculocholecystic shunt. A mortality report

Bernstein, Ronald A.; Hsueh, Wei

doi:10.1016/0090-3019(85)90156-9

Cited by 33 publications

(18 citation statements)

References 17 publications

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“…We were also unable to demonstrate any obvious reflux of saline or bile at the time of removal of the valve up to a pressure of 55 cm H 2 O. This is similar to Bernstein's [1] mortality report in that no reflux was demonstrated during the testing of the valve. Presumably some of the leak might have occurred postoperatively at the time of recovery from anesthesia, when the patient had bucking and coughing that may have generated transient high intra-abdominal pressure, causing the valve to fail.…”

Section: Discussionsupporting

confidence: 81%

“…Although these authors did not have any complications in their series, a mortality has previously been reported from a ventriculo-gallbladder shunt [1]. It is theorized that bile entered the intracranial compartment in this patient, which caused saponification and emulsification of the brain and fatal ventriculitis.…”

Section: Discussionmentioning

confidence: 74%

“…The subsequent development of intense lumbar arachnoiditis further supports the severity of meningeal inflammation that the bile reflux evoked. A mortality has previously been reported following gallbladder shunt [1]. At autopsy, acute biliary ventriculitis was documented along with intense staining of the basal cisterns.…”

Section: Discussionmentioning

confidence: 94%

“…The gallbladder is used when all other sites have been exhausted, to divert CSF in teenage hydrocephalic patients who have undergone multiple shunt revisions, abdominal operations and repeated neck vein cannulations during childhood [1][2][3][4][5]. The mechanism by which bile produces injury is unclear.…”

Section: Discussionmentioning

confidence: 99%

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Chemical Meningitis from Bile Reflux in a Lumbar-Gallbladder Shunt

et al. 1998

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Objective and Importance: The gallbladder is used to divert cerebrospinal fluid (CSF) in patients with hydrocephalus when all other sites have been exhausted. This is seen in hydrocephalic patients who have reached teenage years but have undergone multiple shunt revisions, abdominal operations and repeated neck vein cannulations during childhood. One complication of the lumbar-gallbladder shunt is discussed as well as its pathophysiologic theory and management. Clinical Presentation: A case of a patient with a lumbar-gallbladder shunt who developed chemical meningitis from reflux of bile into the CSF space is presented. The patient presented with generalized seizures. Intervention: Included: ventilatory support, externalization of the shunt, correction of the metabolic abnormalities and administration of anticonvulsants and steroids. Conclusion: This case illustrates an unusual occurrence of reflux of bile into the CNS through a lumbar-gallbladder shunt in a patient with long-term complex communicating hydrocephalus. It also demonstrates its mode of presentation and successful management. To our knowledge, this is the first case report of its kind.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Chemical Meningitis from Bile Reflux in a Lumbar-Gallbladder Shunt

et al. 1998

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“…Described VGBS-specific malfunctions include bilious reflux resulting in ventriculitis 2 or meningitis 1 and cholecystic complications including atony, biliary tract infection, and cholecystitis. 3,4 Bilious peritonitis due to intrabdominal catheter fracture is previously undescribed.…”

mentioning

confidence: 99%