Ventriculo gallbladder shunt as an alternative cerebrospinal fluid diversionary procedure

In the complex management of hydrocephalus, ventriculoperitoneal (VP) shunt insertion is the mainstay for cerebrospinal fluid (CSF) diversion. However, when traditional routes fail or are contraindicated - due to congenital abnormalities, infections, extensive adhesions, or previous abdominal surgeries - surgeons must consider less conventional alternatives. The second line is the ventriculo-atrial shunt then the ventriculo-pleural. The ventriculo-gallbladder (VG) shunt, although rarely used, presents a fascinating option with unique physiological advantages. Here, we present an interesting case of VG shunt insertion in King Faisal specialist hospital, Jeddah.

We present the case of a 12-year-old female with a complex history, including myelomeningocele repair at birth, hydrocephalus managed through multiple VP shunt revisions, and end-stage renal disease. Admitted under general pediatrics with peritonitis, she was treated with a temporary external ventricular drain and VP shunt. However, rapid abdominal distention ensued, and imaging revealed adhesions and collections, ruling out the peritoneum as a feasible shunt site. Given her complex anatomy and limited options, a VG shunt was chosen. Remarkably, at a 3-month follow-up, the patient demonstrated full stability with excellent VG shunt function, highlighting the gallbladder's potential as a reliable CSF reservoir.

The VG shunts have a promising results in terms of absorption and complication rate as documented in the literature. In patients who failed the other commonly used cavities, the gallbladder is a safe and effective organ for absorption.