A Case of Pleural Effusion Caused by Ventriculoperitoneal Shunt and Subphrenic Abscess

Moon, Jin Hwa; Lee, Soo Yong; O, Jae Won; Lee, Ha Baik

Abstract

Several different diseases may have an associated exudative pleural effusion. In a patient with a pleural effusion of unknown origin, a possibility of intra-abdominal abscess should always be considered, especially in a patient who has the past history of abdominal surgery or procedure. We describe a 5-year-old male patient who had been operated for congenital hydrocephalus with ventriculo-peritoneal shunt insertion at 15 months old, admitted to our hospital with complaints of headache and edema of valvular area. Brain CT scan revealed shunt disconnection, and he was operated for insertion of new shunt catheter. Seven days after first operation, he presented fever, abdominal pain and distension. Abdominal ultrasonography revealed bowel adhesion and peritonitis. Staphylococcus epidermidis was isolated by aspiration of shunt valve and reservior, repeatedly. He should have had another 2 operations of peritoneal lavage and catheter change for shunt infection associated peritonitis. Eight days after the 3rd operation, he complained newly developed left shoulder, left chest pain and fever up to 39 degrees C. His chest x-ray revealed pleural effusion on the left side. Though antibiotic therapy was already being conducted, the left pleural effusion and fever aggravated. Repeated ultrasonography disclosed an occult left subphrenic abscess, explaining the fever and left pleural effusion on the radiograph. Fourth operation of abscess drainage and infected shunt removal with extraventricular drainage was done. After the operation, his fever and pleural effision were rapidly disappered, and postoperative CSF culture was negative. A review of ventriculoperitoneal shunt infection associated with subphrenic abscess and pleural effusion was discussed.