VENTRICULO-PLEURAL SHUNT IN AN ADULT RESULTING IN PLEURAL EFFUSION

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: In patients with hydrocephalus, ventriculoperitoneal(VP) shunts are most common treatment due to ease insertion and a more favorable risk profile. However, in instances such as infections anatomical variations, where ventriculoperitoneal unable be placed then ventriculoatrial or ventriculopleural can placed. Ventriculopleural(VPL) commonly children than adults. decreased rates revision have been found older compared younger (2). While VPL well tolerated, they tend higher complication rate shunts(3). One complications shunt is pleural effusion. The invention improvement valves, pressure control devices anti-siphon reduced amount effusions developed by helping for intrathoracic pressure. estimated effusion believed anywhere from 4.5- 62% (1,4). These also become infected at 8-12% (1). Due rarity their complications, these estimations based on often small, single institution studies. CASE PRESENTATION: Our patient 20 year old male past medical history spina bifida, seizure disorder, hydrocephalus s/p VP shunt, Antegrade Colonic Enema(ACE) procedure about 10 years ago urostomy ileal augmentation presented complaint abdominal pain. He was perforated stercoral ulcer subsequently underwent right colectomy loop ileostomy. During this procedure, his exteriorized frank pus necrosis peritoneal cavity. started broad spectrum antibiotics, but he continued purulent drainage JP drain extensive nature infection. After discussions between neurosurgery cardiothoracic surgery, placement. Imaging later showed moderate sized effusion, remained asymptomatic. DISCUSSION: Ventriculoperitoneal way decompress cerebrospinal fluid, if cannot instead. Generally tolerated. Occasionally, develop effusions, has greatly after development shunt. CONCLUSIONS: viable option consider contraindicated; however, it important vigilant assessment possible including effusions. REFERENCE #1: Küpeli, E., Yilmaz, C., & Akçay, S. (2010). Pleural following shunt: reports review literature. Annals thoracic medicine, 5(3), 166–170. https://doi.org/10.4103/1817-1737.65048 #2: Melamed, Edward, Christian, Eisha, Krieger, Mark, Berry, Cherisse, Yashar, Parham McComb, J. (2016). 200 Age Novel Risk Factor Revision Ventriculopleural Shunt Pediatric Patients. Neurosurgery, 63, 178-179. https://doi.org/10.1227/01.neu.0000489769.74513.e8 #3: Craven, Asif, H., Farrukh, A., Somavilla, F., Toma, A. K., Watkins, L. series adults: single-center experience, Journal Neurosurgery JNS, 126(6), 2010-2016. Retrieved Apr 27, 2021, experience DISCLOSURES: No relevant relationships Brittany Gabbert, source=Web Response Michael Akhil Gade, Steven Kim, Machaiah Madhrira, Srinivasan Rajaganapathy,