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Introduction: Ventriculoperitoneal shunt is an established and efficient treatment for hydrocephalus. Peritoneal abscess is a, rare, serious complication which should be managed aggressively. There is no general consensus for managing peritoneal abscess after ventriculo-peritoneal (VP) shunt. Here we present our stepwise protocol of management for a series of five cases. Case presentations: We present a series of five cases diagnosed with peritoneal abscess after VP shunting. Patients were fully investigated on admission. Abscess was confirmed by pelvic-abdominal U/S and diagnostic aspiration. Conservative management was started with antibiotics according to culture and sensitivity initially in all cases. Shunt externalization and apo-cath insertion was done for non-responsive cases. Further non-responsive cases were managed by shunt removal and external ventricular drain (EVD) until subsidence of infection. The study included 3 males and 2 female patients. One case responded to conservative measures, while the other four needed more invasive procedures: apo-cath, shunt removal and EVD with intra-ventricular antibiotics. Conclusion: Abdominal infection following VPS insertion is a serious complication associated with high morbidity and mortality. Patients should be managed in collaboration with general surgery department staff. We propose a management protocol that includes a systematic stepwise approach according to the general condition and neurological status of each patient. The protocol starts with conservative treatment and progresses to more invasive and aggressive methods according to the response of the patient.