Severe constipation: an under-appreciated cause of VP shunt malfunction: a case-based update

Area of Science:

• Pediatric Neurosurgery
• Gastroenterology

Background:

• Increased intra-abdominal pressure can elevate intracranial pressure and cause ventriculoperitoneal (VP) shunt malfunction.
• Patients with neurological deficits, such as myelomeningocele or cerebral palsy, often experience neurogenic bowel and chronic constipation.
• VP shunt failure attributed to constipation, though recognized, is infrequently described.

Purpose of the Study:

• To review the etiopathogenesis, diagnosis, and management of severe constipation leading to VP shunt malfunction.
• To alert pediatric neurosurgeons to consider severe constipation as a potential cause of VP shunt failure, thereby preventing unnecessary surgical interventions.

Main Methods:

• Review of literature on constipation-induced VP shunt malfunction.
• Case reports of two children with VP shunt failure due to severe constipation.
• Analysis of conservative treatment strategies for alleviating increased intra-abdominal pressure.

Main Results:

• Two children experienced transient VP shunt failure due to intense constipation, exacerbating pre-existing hydrocephalus.
• One case involved an anteriorly placed anus, and the other presented with intestinal paresis post-ileostomy.
• Conservative management to reduce intra-abdominal pressure led to complete resolution of VP shunt failure symptoms in both patients.

Conclusions:

• Severe constipation is a critical, often overlooked, cause of VP shunt malfunction in pediatric patients.
• Conservative management of constipation can effectively resolve VP shunt failure, obviating the need for surgical revision.
• Pediatric neurosurgeons should consider constipation in the differential diagnosis of VP shunt malfunction to optimize patient care and avoid unnecessary procedures.