Case report of mesenteric abscess following laparoscopic Roux-en-Y gastric bypass in the setting of a ventriculoperitoneal shunt.

Abstract

We report the management of a 38-year-old female with a history of ventriculoperitoneal (VP) shunt who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) and presented with infected mesenteric abscess. The patient underwent LRYGB and was discharged on postoperative day (POD) #1. She sustained a syncopal event on POD #15, with workup revealing a mesenteric abscess. She underwent operative drainage of the abscess, small bowel resection and revision of her jejunojejunostomy. The VP shunt was visualized intraoperatively and after discussion with the neurosurgery team, externalized. She was treated with empiric intravenous antibiotics, and serial shunt cultures. After persistently negative shunt cultures, she underwent re-internalization of the shunt on POD #12 after drainage and was discharged home. Complications of bariatric surgery in patients with VP shunts can be successfully managed with a high index of clinical suspicion and timely multi-disciplinary cooperation.