Postoperative care for an infant with a ventriculoperitoneal shunt; which finding warrants immediate intervention?

• A. Abdominal distention
• B. Lethargy
• C. Facial edema
• D. Headache

Answer: (A)

The key idea is that a ventriculoperitoneal shunt transfers CSF from the brain into the peritoneal cavity, so problems at the distal end can present as abdominal issues. Abdominal distention in an infant with a VP shunt is a red flag for distal-catheter complications such as shunt infection with peritonitis or a CSF-containing abdominal cyst/pseudocyst. These conditions can progress quickly to sepsis or shunt malfunction if not addressed right away, so immediate assessment and involvement of the surgical team are needed. Lethargy and headache indicate increased intracranial pressure and are serious, but abdominal distention points to a potentially life-threatening abdominal complication related to the shunt that requires urgent intervention. Facial edema is less specific to VP shunt problems in the immediate postoperative period.