Gram-positive peritonitis in patients with infected ventriculoperitoneal shunts

Patients with infected ventriculoperitoneal shunts may, in some situations, present with prominent abdominal signs and symptoms and no neurologic complaints. As a consequence, the correct diagnosis may be confused initially, and the appropriate therapy may be dangerously delayed. Definitive diagnosis is established by percutaneous tap of the shunt reservoir and analysis of the ventricular fluid. If the offending organism is gram-positive, externalization of the shunt combined with systemic and intraventricularly administered antibiotics, without laparotomy, is the treatment of choice. If gram-negative organisms are identified, exploratory laparotomy is indicated to rule out a ruptured viscus. In establishing the correct diagnosis and determining the appropriate therapeutic priorities, the co-operative efforts of the general, as well as the neurologic, surgeon are required.