Sudden death due to ventriculoperitoneal shunt dysfunction: A case report

Ventriculoperitoneal (VP) shunt is a surgical procedure done for hydrocephalus, usually during childhood. Unfortunately, in some cases shunt failure occurs either due to obstruction or disconnection. In rare cases, sudden death can happen due to cerebral edema caused by shunt failure.

We report a rare case of 32-year-old Indian male, who died suddenly. An autopsy revealed obstruction of the left VP shunt, and disconnection of the right VP shunt device just near the burr hole. Both shunt procedures were done in his childhood for obstructive hydrocephalus. Death was attributed to acute diffuse cerebral edema with brain herniation.

VP shunt failure can arise from tissue overgrowth, fibrosis, or mechanical disconnection, all of which may impair CSF drainage and increase intracranial pressure. Severe unilateral hypoplasia of the transverse and sigmoid venous sinuses is a very rare congenital anomaly that can cause hydrocephalus in early childhood. Careful postmortem examination of the shunt system, including patency, positioning, and connection integrity, is essential in such cases to establish the cause of death.

This case illustrates the fatal potential of VP shunt failure. Regular monitoring and long-term follow-up in patients with VP shunts are critical. A thorough forensic autopsy is essential to confirm shunt failure, establish the precise cause of death, and provide valuable insights to prevent similar fatal outcomes in clinical practice. The findings of this case also serve as a useful reference for forensic pathologists when diagnosing rare deaths associated with VP shunt failure.