Peritoneography in the assessment of peritoneal cerebrospinal fluid absorption potential for distal ventriculoperitoneal shunt catheter placement: Technical case report

OBJECTIVE AND IMPORTANCE: Distal ventriculoperitoneal shunt failure has bee n associated with absorption failure secondary to previous peritonitis. Thi s assumption has caused surgeons to seek alternate sites for distal cathete r placement. We propose that the absorptive potential of the peritoneal cav ity should be assessed before that site is discounted for catheter placemen t. CLINICAL PRESENTATION: The case of a 14-month-old male patient is presented , demonstrating multiple ventriculoperitoneal shunt placement procedures an d a diagnostic dilemma with respect to distal shunt placement. Peritoneogra phy was performed to demonstrate peritoneal fluid absorption, allowing subs equent placement of a new distal shunt catheter with good clinical results. TECHNIQUE: Using aseptic technique, a 24-gauge spinal needle was inserted i n the midline of the abdomen and water-soluble contrast material was instil led. Delayed radiographs delineated peritoneal adhesions and demonstrated r enal excretion of the contrast material, confirming peritoneal absorption. CONCLUSION: The peritoneal cavity remains the site of choice for distal shu nt catheter placement. If failure of peritoneal cerebrospinal fluid absorpt ion is suspected as a cause of shunt failure, then peritoneography with wat er-soluble contrast material may be safely used to demonstrate the adequacy of fluid absorption before a secondary site is chosen.