Transient ventriculoperitoneal shunt malfunction after chronic constipation: case report and review of literature

Significant constipation in patients with shunt-dependent hydrocephalus may often be enough to bring a subclinical shunt malfunction to clinical attention or even to be the cause of temporary distal peritoneal shunt malfunction. The treatment of the constipation may address the symptomatic shunt dysfunction so as to avoid operative intervention. The pathogenesis of distal shunt malfunction and its management in such a situation are discussed, and the relevant literature is briefly reviewed. A 16-year-old young boy had shunt-dependent hydrocephalus secondary to prematurity and intraventricular hemorrhage at birth. He was chronic flaccid paraplegic and had a neurogenic bladder and bowel involvement. He presented with acute dull aching intermittent headaches, nausea, and constipation of short duration. There was no underlying shunt infection. CT brain showed dilated lateral ventricles. Shunt survey revealed a convoluted course and kink in the distal peritoneal catheter. After administration of a bowel enema, the headaches and nausea resolved over the next few hours, and the posttreatment CT showed significant decrease in ventricular size. Chronic constipation is an important predisposing factor for distal malfunction in shunt-dependent hydrocephalus and should be ascertained in evaluation of a ventriculoperitoneal shunt malfunction. Appropriate treatment of significant constipation can relieve shunt malfunction and reestablish cerebrospinal fluid circulation. A shunt exploration can be avoided in such a situation. A close neurological monitoring of the patient is essential during the course of treatment. An interdisciplinary approach between concerned medical specialities and enhanced awareness is mandatory to ensure appropriate bowel management.