# Referred Shoulder Pain Due to the Positioning of the Ventriculoperitoneal Shunt: A Case Report and Literature Review of an Unusual Complication

## TL;DR

A rare case of shoulder pain caused by a ventriculoperitoneal shunt positioning is reported, highlighting the need for awareness among physicians.

## Contribution

The paper reports a rare complication of VP shunts and emphasizes the importance of considering this diagnosis in patients with unexplained shoulder pain.

## Key findings

- An 18-year-old male with a VP shunt experienced shoulder pain due to improper shunt positioning.
- Literature review identified six similar cases of shoulder pain linked to VP shunts.
- Surgical repositioning of the shunt resolved the patient's symptoms.

## Abstract

We present the case of an 18-year-old male with a ventriculoperitoneal (VP) shunt for hydrocephalus who experienced right shoulder pain. The patient was thoroughly investigated for gastrointestinal disease, including abdominal ultrasound and upper endoscopy, which revealed no abnormalities that could explain his symptoms. X-ray imaging subsequently revealed that the shunt’s distal peritoneal tubing was positioned in a supra-hepatic subdiaphragmatic location. Surgical shortening and repositioning of the peritoneal tubing successfully alleviated the patient's shoulder pain.

A review of the literature uncovered four articles, comprising a total of six patients, who exhibited similar symptoms of shoulder pain linked to their VP shunts. Given the rarity of this complication, it can be easily overlooked or misdiagnosed. It is crucial for physicians to consider this possibility when evaluating patients with VP shunts who present with shoulder pain to ensure prompt and effective treatment.