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Updated: Jun 6, 2025
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Atypical delayed ventriculoperitoneal shunt infection following hysteroscopic polypectomy: illustrative case
Shannan Bialek1, Baylee Stevens1, Sherwin A Tavakol1
1Departments of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Insights
This case highlights an unusual late-onset ventriculoperitoneal (VP) shunt infection caused by atypical bacteria. Prompt diagnosis and management of such infections are crucial for patient outcomes.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Medical Case Reports
Background:
- A 36-year-old female with a history of congenital hydrocephalus and prior ventriculoperitoneal (VP) shunt procedures presented with signs of abdominal incision infection.
- The patient had a distal VP shunt catheter exiting through an abdominal incision, which showed erythema, induration, and drainage.
- A recent minor gynecological procedure was the only identified potential risk factor for infection.
Purpose of the Study:
- To report a rare case of late-onset, polymicrobial ventriculoperitoneal shunt infection.
- To emphasize the importance of considering uncommon pathogens and atypical presentations in shunt-related infections.
- To highlight the diagnostic and management challenges associated with unusual shunt infections.
Main Methods:
- Wound cultures from the abdominal incision revealed Cutibacterium acnes, Corynebacterium species, and Mycobacterium chelonae.
- The patient's management involved initial externalization of the shunt, followed by complete explantation after a successful clamp trial.
- Treatment consisted of a prolonged course of intravenous and oral antibiotics tailored to the identified polymicrobial infection.
Main Results:
- The abdominal wound cultures identified an atypical polymicrobial infection.
- The shunt system was successfully explanted after a clamp trial.
- The patient completed a course of antibiotics, and the abdominal wound healed appropriately under close monitoring.
Conclusions:
- Most shunt infections involve typical organisms and occur within a specific timeframe.
- This case underscores the need for comprehensive evaluation and follow-up of shunt-treated patients presenting with potential infections, even with atypical timelines or presentations.
- The possibility of uncommon infecting organisms should be considered in all shunt-related infections.
Background:
A 36-year-old female with a history of congenital hydrocephalus, treated with ventriculoperitoneal (VP) shunt placement at 3 months of age and a shunt revision at 9 years of age, presented with erythema, induration, and drainage of an abdominal incision through which the distal catheter of her VP shunt had been implanted many years prior. She had no recent risk factors for infection apart from a minor transvaginal gynecological procedure that involved hysteroscopy with dilation and curettage for uterine polyps.
Observations:
Abdominal wound cultures grew Cutibacterium acnes, Corynebacterium species, and Mycobacterium chelonae. She was managed with initial externalization, followed by complete explantation of her shunt system following a successful clamp trial; in tandem, the atypical polymicrobial infection was treated with a prolonged regimen of intravenous antibiotics followed by oral antibiotics and close monitoring of the wound, which healed appropriately.
Lessons:
Although the majority of shunt infections occur due to a characteristic set of organisms within an expected time frame, this case emphasizes the importance of a thorough workup and follow-up for shunt-treated patients with potential infections-even when they fall outside the usual window or have an atypical presentation-for the possibility of uncommon infecting organisms. https://thejns.org/doi/10.3171/CASE24472.
