Letter to the Editor. Shunt dysfunction and constipation

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To THE EDITOR: We appreciated the article by Morais et al.2 describing a 6-year-old shunt-treated spina bifida patient in the emergency department, presenting with mixed symptoms of shunt malfunction and abdominal pathology (Morais BA, Cardeal DD, Andrade FG, et al: Reversible ventriculoperitoneal shunt dysfunction and chronic constipation: case report. J Neurosurg Pediatr 22:147–150, August 2018). The authors demonstrate concomitant ventricular dilatation and abdominal constipation, which resolved with nonsurgical management. The discussion included the possibility that intracranial hypertension could cause bowel dysfunction. At our institution, we frequently observe the clinical phenomenon of transient shunt malfunction

Article Information

Correspondence Carolyn Quinsey: carolyn_quinsey@med.unc.edu.

INCLUDE WHEN CITING Published online November 30, 2018; DOI: 10.3171/2018.9.PEDS18557.

Disclosures The authors report no conflict of interest.

© AANS, except where prohibited by US copyright law.

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    The first patient’s asymptomatic baseline imaging is shown (A and D), along with evidence of ventricular enlargement and increased stool burden (B and E), with resolution after medical management of constipation (C and F). The second patient’s asymptomatic baseline imaging is also shown (G and J). Ventricular enlargement along with increased caliber of cervical syrinx was seen (H and K), that resolved with aggressive bowel regimen (I).

References

1

Martínez-Lage JFMartos-Tello JMRos-de-San Pedro JAlmagro MJ: Severe constipation: an under-appreciated cause of VP shunt malfunction: a case-based update. Childs Nerv Syst 24:4314352008

2

Morais BACardeal DDAndrade FGPaiva WSMatushita HTeixeira MJ: Reversible ventriculoperitoneal shunt dysfunction and chronic constipation: case report. J Neurosurg Pediatr 22:1471502018

3

Uzzo RGBilsky MMininberg DTPoppas DP: Laparoscopic surgery in children with ventriculoperitoneal shunts: effect of pneumoperitoneum on intracranial pressure—preliminary experience. Urology 49:7537571997

4

Wisoff JHKratzert KJHandwerker SMYoung BKEpstein F: Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature. Neurosurgery 29:8278311991

1

Bragg CLEdwards-Beckett JEckle NPrincipe KTerry D: Shunt dysfunction and constipation: Could there be a link? J Neurosci Nurs 26:91941994

2

Martínez-Lage JFMartos-Tello JMRos-de-San Pedro JAlmagro MJ: Severe constipation: an under-appreciated cause of VP shunt malfunction: a case-based update. Childs Nerv Syst 24:4314352008

3

Muzumdar DVentureyra ECG: Transient ventriculoperitoneal shunt malfunction after chronic constipation: case report and review of literature. Childs Nerv Syst 23:4554582007

4

Powers CJGeorge TFuchs HE: Constipation as a reversible cause of ventriculoperitoneal shunt failure. Report of two cases. J Neurosurg 105 (3 Suppl):2272302006

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