J Korean Med Sci 2010; 25: 647-50 ISSN 1011-8934 DOI: 10.3346/jkms.2010.25.4.647 Acute Shunt Malfunction after Cesarean Section Delivery: A Case Report Shunt malfunctions that require surgical intervention during pregnancy and the postpartum period are rare. Furthermore, no study has reported on an acute shunt malfunction immediately after cesarean section. Here, we describe the case of a 32-yr-old woman who became drowsy 12 hr after cesarean section delivery of her second child. She had a ventriculoperitoneal shunt placed to treat hydrocephalus associated with meningitis at 26 yr of age. Marked ventriculomegaly was seen on brain computed tomography and her consciousness recovered temporarily after aspirating cerebrospinal fluid from the flushing device. At surgery, the distal catheter tip was plugged by a blood clot. We believe that the blood spilled over during the cesarean section. The clogged catheter end was simply cut off and the remaining catheter was repositioned in the peritoneal cavity. Her consciousness recovered fully. Key Words : Ventriculoperitoneal Shunt; Prosthesis Failure; Hydrocephalus; Cesarean Section ⓒ 2010 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Sun-Chul Hwang1, Tae-Hee Kim2, Bum-Tae Kim1, Soo-Bin Im1, and Won-Han Shin1 Department of Neurosurgery1, and Obstetrics and Gynecology2, Soonchunhyang University Bucheon Hospital, Bucheon, Korea Received : 25 June 2008 Accepted : 20 January 2009 Address for Correspondence Sun-Chul Hwang, M.D. Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon 420-747, Korea Tel : +82.32-621-5291, Fax : +82.32-621-5016 E-mail : sunchulh@sch.ac.kr INTRODUCTION Cerebrospinal fluid (CSF) shunts are a definite treatment for hydrocephalus. As increasing numbers of women have CSF shunts placed to treat hydrocephalus, more shunt-depen- dent women are becoming pregnant (1, 2). Although the maternal and fetal outcome in patients with ventriculoperi- toneal (VP) shunts is uniformly excellent, the changes in the abdominal cavity, such as the enlargement of the uterus and increased abdominal pressure, could cause shunt failure (1, 3-5). The distal shunt catheter is frequently obstructed in pregnancy, especially during the third trimester when the intra-abdominal pressure is thought to be highest (3, 4). Post- partum shunt complications are rare (1, 4, 6, 7), and shunt obstruction immediately after a cesarean section had not been reported. We present a patient with a VP shunt who had reduced consciousness due to obstruction of the abdominal shunt catheter immediately after a cesarean section delivery. CASE REPORT A 32-yr-old woman, G2P2A0L2, came to the emergency department complaining that she felt drowsy. She had under- gone a cesarean section delivery of a full-term healthy baby 647 (3,200 gm) the day before. At the age of 26 yr, she had a VP shunt placed to treat hydrocephalus associated with menin- gitis. She underwent a shunt revision when she was 29 yr old. At that time, she was in the sixth month of her first preg- nancy and complained of drowsiness and headache. Her hus- band said that the reason for the shunt malfunction had not been determined and the malfunctioning VP shunt had been replaced with a new device. The revision surgery had success- fully relieved her symptoms. At full term, she underwent a lower segment cesarean section because of fetal distress and gave birth to her first child, who weighed 3,580 g. The post- partum course was unremarkable after the birth of her first child. At 31 yr of age, she became pregnant with her second child. She had no symptoms related to shunt malfunction during gestation. A repeated cesarean section was performed at the same private obstetrics clinic and a healthy baby was deliv- ered. The peritoneal cavity was not irrigated and the shunt tube was not observed at surgery. She began to complain of a headache 12 hr after the cesarean section. Her consciousness deteriorated gradually and she became drowsy. She was trans- ferred to our hospital 24 hr postoperatively. In the emergency room, she did not open her eyes spontaneously and her ver- bal response was very slow and inappropriate. Ventriculome- galy with a bifrontal index of 41% was seen on brain com-