Ventriculo gallbladder shunt as an alternative cerebrospinal fluid diversionary procedure

Background: In the complex management of hydrocephalus, ventriculoperitoneal (VP) shunt insertion is the mainstay for cerebrospinal fluid (CSF) diversion. However, when traditional routes fail or are contraindicated - due to congenital abnormalities, infections, extensive adhesions, or previous abdominal surgeries - surgeons must consider less conventional alternatives. The second line is the ventriculo-atrial shunt then the ventriculo-pleural. The ventriculo-gallbladder (VG) shunt, although rarely used, presents a fascinating option with unique physiological advantages. Here, we present an interesting case of VG shunt insertion in King Faisal specialist hospital, Jeddah. Case Description: We present the case of a 12-year-old female with a complex history, including myelomeningocele repair at birth, hydrocephalus managed through multiple VP shunt revisions, and end-stage renal disease. Admitted under general pediatrics with peritonitis, she was treated with a temporary external ventricular drain and VP shunt. However, rapid abdominal distention ensued, and imaging revealed adhesions and collections, ruling out the peritoneum as a feasible shunt site. Given her complex anatomy and limited options, a VG shunt was chosen. Remarkably, at a 3-month follow-up, the patient demonstrated full stability with excellent VG shunt function, highlighting the gallbladder's potential as a reliable CSF reservoir. Conclusion: The VG shunts have a promising results in terms of absorption and complication rate as documented in the literature. In patients who failed the other commonly used cavities, the gallbladder is a safe and effective organ for absorption.