An Atypical Presentation of Pancreatitis Secondary to a Ventriculoperitoneal Shunt

Ventriculoperitoneal (VP) shunts are catheters inserted to drain excess cerebrospinal fluid (CSF) when there is an obstruction in the normal outflow or a decreased absorption of the fluid leading to hydrocephalus. Recognised complications of placement of the distal catheter are malposition, obstruction, pseudocysts and infection. Here, we present a case of a 23-year-old female with acute pancreatitis following the placement of a VP shunt in the lesser sac. The patient originally had a VP shunt placed in infancy for congenital hydrocephalus with one revision at four years old. She presented with a three-day history of worsening epigastric pain with an associated lipase of 3030 (10-60IU), CRP 157 (<5mg/L) and normal liver function tests. A CT scan showed acute pancreatitis with an associated collection within the lesser sac extending to the greater omentum. This was due to the malposition of the VP shunt after a recent revision surgery. It was managed with a diagnostic laparoscopy, washout and shunt externalisation. This is an atypical presentation of acute pancreatitis secondary to a VP shunt. A high index of suspicion is needed for diagnosis. Management of both pancreatitis and VP shunt complications need to be considered.