What About the Gallbladder? A Case Series of Experience and Outcomes in Pediatric Ventriculogallbladder Shunts.

INTRODUCTION

Hydrocephalus treatment via shunting to the peritoneum, atrium, or pleural space may be contraindicated in pediatric patients with complex surgical history or small size. We aim to describe experience and outcomes of ventriculogallbladder shunt (VGBS) placement.

METHODS

A retrospective review was performed of all patients (<18 y) who underwent VGBS placement at a single quaternary children's hospital (January 1, 2014-October 31, 2025). Patients were identified by Current Procedural Terminology code and operative records. Demographics, past medical history, prior shunt history, indication for VGBS, subsequent revisions, and duration were collected. Descriptive statistics were utilized.

RESULTS

Five male patients were identified with a median age at VGBS placement of 6.9 mo (interquartile range [IQR] 5.9, 9.0). Four patients developed hydrocephalus secondary to neonatal intraventricular hemorrhage and one from obstructive intracranial malignancy. All patients had intra-abdominal pathology: three necrotizing enterocolitis, one omphalocele and intestinal atresia, and one dysfunctional peritoneum. One patient had a ventriculoperitoneal shunt, ventriculoatrial shunt, and ventriculopleural shunt prior to VGBS, three patients had prior ventriculoperitoneal shunt, and one patient had no prior shunts. Of the four patients with prior shunt placement, the median age at first drainage procedure was 4.1 mo (IQR 3.0, 4.8) with a median of 4.5 revisions (IQR 3.5, 7.5) prior to VGBS. Three of the five VGBS remain functional after 2.4, 4.8, and 7.2 y with two patients undergoing conversion to ventriculopleural shunts (1.4 and 6.8 y postplacement).

CONCLUSIONS

The gallbladder is a feasible and vital consideration for distal ventricular shunt placement in children of small size and/or intra-abdominal pathology which prohibit traditional locations.