Presentation
Sharp right lower abdominal pain and groin pain for 5 days followed by swelling over the abdominal wound and lumbar surgical wound sites, headache and blurring of vision. Background history of benign intracranial hypertension; patient had undergone lumboperitoneal shunt insertion (with programmable valve) 12 months prior.
Patient Data
In the axial image, the intraperitoneal portion is noted to be dislodged, with pooling of CSF into the subcutaneous tissue in the anterolateral and posterior abdominal walls. The intrathecal catheter tip remains in situ whereas the intraperitoneal catheter is noted to be coiled in the abdominal wall. The sagittal image shows the same dislodged intraperitoneal portion of catheter.
Case Discussion
Lumboperitoneal shunt (LP) is a CSF diversionary procedure for the treatment of benign intracranial hypertension (synonym: pseudotumor cerebri, idiopathic intracranial hypertension). This involves insertion of an intrathecal shunt (with or without an attached valve) which is tunneled under the skin and into the peritoneum. Such catheters are at risk of becoming dislodged with increased intra-abdominal pressure, as occurs with obesity. The patient underwent urgent revision of her LP shunt, intra-operative findings: shunt tip, tubing and valve were coiled in pre-peritoneal space.
(The author wishes to acknowledge Dr. Vinod Rajasingam for providing additional images for this case)
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