A54-36 Pneumatosis Intestinalis, an Uncommon Complication in a Patient With Ventriculoperitoneal Shunt

Abstract Introduction Ventriculoperitoneal (VP) shunts are frequently used to manage hydrocephalus and are usually associated with intra-abdominal complications, such as infections and pseudocysts. Pneumatosis intestinalis (PI) is infrequently reported as a complication of VP shunts. We present a case that explores the rare occurrence of PI in a patient with a VP shunt. Case Presentation A 27-year-old male with a history of cerebral palsy, epilepsy, and hydrocephalus with multiple revisions of the VP shunt presented with abdominal pain, vomiting, and an acute change in mental status. Imaging revealed air-fluid levels, gastric distension, and air in the wall of the duodenum, suggesting PI. The patient was admitted to the intensive care unit for close monitoring. The appearance of pneumoperitoneum further complicated his clinical course. The patient was initially managed conservatively with antibiotics and nasogastric tube decompression; however, due to lack of significant improvement, the patient ultimately underwent exploratory laparotomy, which revealed a VP shunt embedded in the abdominal wall and a 2nd VP shunt with a large knot intertwined in the bowel that was safely removed. The patient subsequently underwent VP shunt revision, during which an external ventricular drain (EVD) was placed and the VP shunt was replaced. Over the course of treatment, the patient's symptoms resolved, and repeat imaging demonstrated resolution of the pneumatosis intestinalis. Discussion Pneumatosis intestinalis is characterized by the presence of gas within the bowel wall and is typically diagnosed via cross-sectional imaging. While PI is commonly associated with gastrointestinal conditions, like bowel ischemia or inflammatory diseases, it can also be secondary to infections, mechanical obstruction, or trauma. The management of PI is complex, from conservative management to urgent surgical intervention, depending on the severity of the condition and the underlying cause. Only a handful of case reports have reported VP shunts causing PI, and even fewer have reported pneumoperitoneum. The proposed mechanism is that the bowel injury by the distal end of the shunt catheter can introduce gas-forming bacteria into the bowel wall. This results in the formation of intramural gas, leading to the development of PI. The case presented highlights the importance of considering VP shunt complications as a potential underlying cause of PI and tailoring treatment accordingly based on the severity and underlying etiology of the condition. It is imperative to remain vigilant in identifying PI in these patients, as early recognition and appropriate management can lead to favorable outcomes. This abstract is funded by: None