A ventriculoperitoneal shunt incidentally found in the stoma
Published in the journal Radiology Case Reports, the authors present a case of a ventriculoperitoneal shunt incidentally found within the stomach while the patient was undergoing a percutaneous endoscopic gastrostomy (PEG) tube placement.

A 72-year-old male with a past medical history of cerebral aneurysm clipping in 2011 status post VP shunt placement, seizures, transfusion dependent anemia and recent diagnosis of West Nile encephalitis presented to the emergency department for failure to thrive and was subsequently admitted for management of fever of unknown origin.

Gastroenterology was consulted for PEG tube placement for low PO uptake. During the procedure another tube was found within the stomach. The tube was initially thought to be a retained enteric tube; however, there were some difficulties in attempts to remove the tube. Further chart reviews revealed a previous VP shunt history.

A new PEG tube was successfully placed, and the following CT abdomen and head confirmed the presence of a VP shunt terminating in the stomach fundus. During hospitalization the patient was found to be anemic with GUIAC positive test requiring blood transfusions.

The patient's Omaya port of the VP shunt was palpable in the right frontal lobe. The shunt was palpable over the right clavicle. The timing or facility were the VP shunt was placed was unknown. The patient was treated with antibiotics. Shunt removal was initially considered, however the patient was found to be clinically stable and his fever resolved with antibiotics, and therefore surgery was not offered.

There was no evidence of shunt malfunction, or of retrograde flow of stomach contents into the shunt. Evaluation of shunt function was somewhat limited due to the patient's nonverbal baseline physical exam; however, there was no evidence of hydrocephalus on head CT.

The patient was febrile on admission, but his fever improved after Zosyn and Vancomycin and therefore his fever was attributed to his known urinary tract infection (UTI).

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