Pneumocephalus in a patient with a ventriculoperitoneal shunt after percutaneous gastrojejunostomy catheter placement: case report.
BACKGROUND
Percutaneous gastrostomy and/or jejunostomy associated with ventriculoperitoneal (VP) shunting in critically ill neurosurgical patients is not an uncommon combination. Massive intraventricular pneumocephalus has not been previously reported as a complication of percutaneous gastrostomy and/or jejunostomy placement in a patient with a VP shunt. A case is presented here where we believe such a complication occurred.


METHODS
Our patient is a 68-year-old woman who experienced a subarachnoid hemorrhage from a right anterior choroidal aneurysm rupture. The patient underwent endovascular coiling. The patient developed a communicating hydrocephalus and eventually necessitated a VP shunt. Two weeks after shunt placement, our patient had a fluoroscopic percutaneous gastrostomy and/or jejunostomy catheter placed. A computed tomographic scan of the brain obtained after feeding tube placement for a change in mental status revealed a significant amount of air in the lateral ventricles. The patient was managed expectantly over the next several days with slow clinical and radiographic improvement.


CONCLUSIONS
The etiology for the increased intraventricular pneumocephalus is believed to be retrograde leakage of air into the ventricles via the VP shunt during insufflation of the abdomen for percutaneous placement of a gastrojejunostomy feeding tube.
Jea
Andrew
A
Department of Neurological Surgery, University of Miami School of Medicine, Lois Pope LIFE Center, Miami, FL 33136, USA. andrew_jea@hotmail.com
Baskaya
Mustafa K
MK
Farhat
Hamad
H
Benglis
David
D
Zauner
Alois
A
D000368:Aged; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000628:therapy; D007582:Jejunostomy / Q000009:adverse effects*; D011007:Pneumocephalus / Q000000981:diagnostic imaging / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000150:complications; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*