Unexpected childhood death due to a rare complication of ventriculoperitoneal shunting

A 10-year-old boy with Arnold-Chiari malformation, spina bifida, and a vent riculoperitoneal shunt for hydrocephalus died unexpectedly, having appeared to be only mildly unwell with fever on the night before death. At autopsy, the shunt was partially obstructed with an associated enterococcal meningi tis. The tip of the shunt was located within the transverse colon, which wa s embedded in a mass of fibrous adhesions resulting from previous abdominal surgery. Blood cultures were sterile. Intestinal perforation is a rare com plication of ventriculoperitoneal shunting that may be associated with the development of meningitis and unexpected death. The autopsy assessment of c hildren with such indwelling devices requires examination of the functional state of the shunt, full septic workup, and determination of the precise l ocation of the tip of the catheter within the peritoneal cavity.