LAUSR

A 74-year-old patient with a history of chronic hydrocephalus treated 8 years before by ventriculoperitoneal shunt (VPS) was admitted in intensive care unit for coma (Glasgow Coma Scale score of 9) and fever. Brain magnetic resonance imaging (MRI) showed a single brain abscess located in the right frontal lobe (Fig. 1, Panel A— arrowhead, Panel B—asterisk) surrounding the end of the ventriculoperitoneal shunt. Cerebrospinal fluid culture from VPS showed different species of Enterobacteria and Enterococcus suggesting a digestive complication. Abdominal computed tomography (CT) scan found neither peritoneal effusion nor abdominal abscess. However, it revealed the aberrant location of the VPS end within the small bowel lumen (Fig. 1, Panel C and Panel D). The main hypothesis for this rare complication is an asymptomatic fistulization between the end of the VPS catheter and the small bowel loop. In patients with VPS and a central nervous system infection due to Gram-negative bacteria, intra-abdominal path of the VPS catheter should be carefully explored to rule out its misplacement.