title: Peritoneography in the assessment of peritoneal cerebrospinal fluid absorption potential for distal ventriculoperitoneal shunt catheter placement: technical case report.
abstract: OBJECTIVE
  Distal ventriculoperitoneal shunt failure has been associated with absorption failure secondary to previous peritonitis. This assumption has caused surgeons to seek alternate sites for distal catheter placement. We propose that the absorptive potential of the peritoneal cavity should be assessed before that site is discounted for catheter placement.
  
  
  METHODS
  The case of a 14-month-old male patient is presented, demonstrating multiple ventriculoperitoneal shunt placement procedures and a diagnostic dilemma with respect to distal shunt placement. Peritoneography was performed to demonstrate peritoneal fluid absorption, allowing subsequent placement of a new distal shunt catheter with good clinical results.
  
  
  METHODS
  Using aseptic technique, a 24-gauge spinal needle was inserted in the midline of the abdomen and water-soluble contrast material was instilled. Delayed radiographs delineated peritoneal adhesions and demonstrated renal excretion of the contrast material, confirming peritoneal absorption.
  
  
  CONCLUSIONS
  The peritoneal cavity remains the site of choice for distal shunt catheter placement. If failure of peritoneal cerebrospinal fluid absorption is suspected as a cause of shunt failure, then peritoneography with water-soluble contrast material may be safely used to demonstrate the adequacy of fluid absorption before a secondary site is chosen.
authors.affiliation: Department of Neurosurgery, Royal Victoria Hospital, Belfast, Northern Ireland BT12 6BA. mcauleydavidj@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: McAuley
authors.forename: A C
authors.initials: AC
authors.lastname: Dick
authors.forename: A
authors.initials: A
authors.lastname: Paterson
mesh_terms: D000042:Absorption; D002555:Cerebrospinal Fluid / Q000502:physiology*; D004868:Equipment Failure; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000601:surgery*; D007223:Infant; D008297:Male; D008591:Meningomyelocele / Q000000981:diagnostic imaging / Q000601:surgery*; D010537:Peritoneum / Q000000981:diagnostic imaging*; D011859:Radiography; D012086:Reoperation; D017287:Ventriculoperitoneal Shunt