Shunt Revision to Ventriculoatrial Shunt Due to Long-Term Abdominal Distension Complicated by Neonatal Necrotizing Enterocolitis and Cerebrospinal Fluid Overproduction after Ventriculoperitoneal Shunt for the Management of Post-Hemorrhagic Hydrocephalus: A Case Report

Abstract

Corresponding author: Soo Han Yoon Department of Neurosurgery, Ajou University Medical Center, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon 16499, Republic of Korea Tel: +82-31-219-5233 Fax: +82-31-219-5238 E-mail: ee80@hanmail.net A cerebrospinal fluid (CSF) shunt is the most common treatment known to date in the treatment of hydrocephalus. A ventriculoperitoneal (VP) shunt is one of the most commonly favored procedures for CSF diversion. We present a case of shunt revision from a VP shunt to a ventriculoatrial (VA) shunt. The patient was diagnosed with germinal matrix hemorrhage with intraventricular hemorrhage shortly after birth with a history of ileostomy surgery for neonatal necrotizing enterocolitis 10 days after birth. The patient began to develop hydrocephalus around 7 weeks after birth and she had VP shunt surgery at 6 months old for post-hemorrhagic hydrocephalus. After the VP shunt surgery, the patient experienced several months of vomiting and constipation along with worsening of the abdominal distension. Distal abdominal catheter externalization was temporarily performed, and 20 to 30 mL/kg of CSF was drained daily. Abdominal distension was still not resolved after 2 weeks and VA shunting was performed. The patient was discharged with improved abdominal distension and was followed for 3 years without any complications. We report a relatively rare case of a shunt revision to VA shunt due to long-term abdominal distension complicated by neonatal necrotizing enterocolitis and CSF overproduction after VP shunting.