OBJECTIVE AND IMPORTANCE: This report describes an important technical
modification in ventriculoperitoneal shunting. CLINICAL PRESENTATION:
A young woman presented with shunt malfunction caused by occlusion of
the peritoneal catheter. Conventional sites for placement of distal c
atheter were unavailable or had been used up. INTERVENTION: After the
installation of a ventriculopleural shunt resulted in pleural effusion
, it was converted to a transdiaphragmatic ventriculoperitoneal shunt,
resulting in an excellent clinical outcome. CONCLUSION: The suprahepa
tic subdiaphragmatic space can be directly accessed in some selected p
atients with extensive peritoneal adhesions, resulting in successful v
entriculoperitoneal shunting.