Laparoscopic repositioning of an obstructed ventriculoperitoneal shunt catheter with laparoscopy-assisted partial omentectomy and omentopexy

Abstract

Objective: To describe the use of laparoscopy for repositioning of a ventriculoperitoneal shunt (VPS) catheter. Study design: Case report. Animal: One 11-month-old male cairn terrier weighing 5.5 kg. Methods: The dog had placement of a VPS system for primary hydrocephalus at 4 months of age. Poor functioning of the shunt system was suspected because of deteriorating neurological signs. A contrast study of the VPS system provided evidence of a distal shunt obstruction, and repeated brain computed tomography (CT) was consistent with persistent hydrocephalus. Results: Laparoscopy was used to free the abdominal catheter of the shunt system and perform a partial omentectomy and omentopexy of the remaining omentum. Concurrently, the dog was sterilized. Recovery was routine, and follow-up CT 1 year after repositioning revealed that the hydrocephalus had substantially improved. Results of a contrast study of the VPS system also provided evidence that it was functional. Conclusion: Ventriculoperitoneal shunt systems are placed in dogs with primary and secondary hydrocephalus, and complications are quite common, including obstruction, bleeding, infection, and overshunting or undershunting. This is the first published clinical case report in which the repositioning of a VPS catheter with partial omentectomy and omentopexy in a dog are described. Clinical significance: Future studies may be performed to determine whether laparoscopy can be considered as a treatment to assist with safe placement of VPS systems, avoiding misplacement of the shunt system and iatrogenic damage to the viscera and vessels.