title: [Secondary penetration of a ventriculo-peritoneal shunt into the intestines. Possible cause of a recurring sepsis?].
abstract: We present a 28-year-old-patient with a severe head injury: skull fractures, epidural hematoma, subarachnoid hemorrhage, Glasgow coma score 7, and aspiration following a motorbike accident. A systemic infection with symptoms of shock and Staphylococcus aureus in blood culture specimens developed a few days after admission (later Staphylococcus epidermidis was also cultured). A posttraumatic hydrocephalus was treated by a ventriculo-peritoneal shunt inserted at mini-laparotomy. In multiple microbiological and cytological tests the cerebrospinal fluid (CSF) was always sterile. Enterocolitis occurred with Clostridium difficile and Staphylococcus aureus in stool cultures. After 6 months' intractable sepsis the patient died with multiple-system failure. Autopsy revealed secondary displacement of the shunt catheter into the intestinal lumen. A possible ascending infection was found in the form of a cerebral ventricular empyema. However, prior to death there was no specific clinical sign of peritonitis or encephalitis or a positive microbiological or cytological CSF findings. Despite insertion of a ventriculo-peritoneal shunt under visual control, this case shows that secondary displacement of the peritoneal extremity into the bowel can occur, which may cause a cerebral and eventually a systemic infection. CSF examinations may fail to show contamination; specific clinical signs may be absent or, with multiple-system failure, misleading. An autopsy is generally to be recommended as it contributes to a better understanding of the clinical problems in most cases.
authors.affiliation: Institut für Pathologie, Klinikum Nürnberg.
authors.forename: A
authors.initials: A
authors.lastname: Woltmann
authors.forename: G
authors.initials: G
authors.lastname: Boeden
authors.forename: A
authors.initials: A
authors.lastname: Diaz
authors.forename: P
authors.initials: P
authors.lastname: Ortloff-Kittredge
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002552:Cerebral Ventricles / Q000601:surgery*; D003015:Clostridium Infections / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications*; D004760:Enterocolitis / Q000209:etiology*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000601:surgery*; D008297:Male; D010537:Peritoneum / Q000601:surgery*; D013203:Staphylococcal Infections / Q000209:etiology
vernacular_title: Sekundäre Penetration eines ventrikulo-peritonealen Shunts in den Darm. Mögliche Ursache einer rezidivierenden Sepsis?