J Korean Neurosurg Soc.  2013 Nov;54(5):441-443. 10.3340/jkns.2013.54.5.441.

Multiple Liver Abscesses Associated with Ventriculoperitoneal Shunt Infection: Case Report and Review of the Literature

• Yang TK
• Sim KB

• KMID: 2138365
• DOI: http://doi.org/10.3340/jkns.2013.54.5.441

Abstract

Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy.

Keyword

Liver abscess; Catheter-related infections

MeSH Terms

Abscess
Anti-Bacterial Agents
Catheter-Related Infections
Diagnosis
Drainage
Female
Humans
Liver Abscess*
Liver*
Middle Aged
Staphylococcus
Ventriculoperitoneal Shunt*
Anti-Bacterial Agents

Figure

• 

  Fig. 1 A : Sagittal abdominal computed tomography (CT) showing a part of the peritoneal catheter (arrow) in the liver with multiple cystic cavities around it. B : Axial enhanced abdominal CT showing the long segment of the peritoneal shunt (arrow) in the liver contacting the upper big cyst. C : The tip of the shunt (arrow) is embedded within the loculated lower cyst. Culture of drainage fluid was positive for S. capitis.

Reference

1. Alvarez JA, González JJ, Baldonedo RF, Sanz L, Carreño G, Jorge JI. Single and multiple pyogenic liver abscesses : etiology, clinical course, and outcome. Dig Surg. 2001; 18:283–288. PMID: 11528137.

2. Borkar SA, Kasliwal M, Mahapatra AK. Intrahepatic abscess complicating ventriculoperitoneal shunt. J Pediatr Neurosci. 2007; 2:16–17.

3. Farrell RJ, Krige JE, Beningfield SJ, Terblanche J. Pyrogenic liver abscess following infection of a ventriculoperitoneal shunt. Am J Gastroenterol. 1994; 89:140. PMID: 8273791.

4. Fisher RA, Rodziewicz G, Selman WR, White RJ, Vibhakar SD. Liver abscess : complication of a ventriculoperitoneal shunt. Neurosurgery. 1984; 14:480–482. PMID: 6728151.

5. Handa R, Kale R, Harjai MM. Unusual complication of ventriculoperitoneal shunt : anal extrusion. Med J Armed Forces India. 2007; 63:82–84.

6. Huang LT, Chen CC, Shih TT, Ko SF, Lui CC. Pyogenic liver abscess complicating a ventriculoperitoneal shunt. Pediatr Surg Int. 1998; 13:6–7. PMID: 9391193.

7. Kanojia R, Sinha SK, Rawat J, Wakhlu A, Kureel S, Tandon R. Unusual ventriculoperitoneal shunt extrusion : experience with 5 cases and review of the literature. Pediatr Neurosurg. 2008; 44:49–51. PMID: 18097191.

8. Mechaber AJ, Tuazon CU. Hepatic abscess : rare complication of ventriculoperitoneal shunts. Clin Infect Dis. 1997; 25:1244–1245. PMID: 9402391.

9. Paone RF, Mercer LC. Hepatic abscess caused by a ventriculoperitoneal shunt. Pediatr Infect Dis J. 1991; 10:338–339. PMID: 1905800.

10. Peterfy CG, Atri M. Intrahepatic abscess : a rare complication of ventriculoperitoneal shunt. AJR Am J Roentgenol. 1990; 155:894–895. PMID: 2119130.

11. Reddy SC. Subcapsular hepatic abscess : a rare complication of ventriculoperitoneal shunt. South Med J. 1987; 80:1309–1311. PMID: 3310253.

12. Shen MC, Lee SS, Chen YS, Yen MY, Liu YC. Liver abscess caused by an infected ventriculoperitoneal shunt. J Formos Med Assoc. 2003; 102:113–116. PMID: 12709741.