Pneumocephalus in a patient with a ventriculoperitoneal shunt after percutaneous gastrojejunostomy catheter placement: case report

Background: Percutaneous gastrostomy and/or jejunostomy associated with ventriculoperitoneal (VP) shunting in critically ill neurosurgical patients is not all uncommon combination. Massive intraventricular pneumocephalus has not been previously reported as a complication of percutaneous gastrostomy and/or jejunostomy placement in a patient with a VP shunt. A case is presented here where we believe such a complication occurred. Case Description: Our patient is a 68-year-old woman who experienced a subarachnoid hemorrhage from a right anterior choroidal aneurysm rupture. The patient underwent endovascular coiling. The patient developed a communicating hydrocephalus and eventually necessitated a VP shunt. Two weeks after shunt placement, our patient had a fluoroscopic percutaneous gastrostomy and/or jejunostomy catheter placed. A computed tomographic scan of the brain obtained after feeding tube placement for a change in mental status revealed a significant amount of air in the lateral ventricles. The patient was managed expectantly over the next several days with slow clinical and radiographic improvement. Conclusions: The etiology for the increased intraventricular pneumocephalus is believed to be retrograde leakage of air into the ventricles via the VP Shunt during insufflation of the abdomen for percutaneous placement of a gastrojejunostomy feeding tube. (c) 2006 Elsevier Inc. All rights reserved.