Delayed presentation of iatrogenic ventriculoperitoneal shunt transection following laparoscopic weight loss surgery in a patient with idiopathic intracranial hypertension

Abstract

Idiopathic intracranial hypertension is strongly associated with central obesity and consequential raised intra-abdominal pressure. If left untreated it poses significant risk to vision and can eventually cause blindness. Owing to its pathophysiology, this condition is managed by both medical and surgical specialities. When medical management fails neurosurgeons commonly treat idiopathic intracranial hypertension by permanent cerebrospinal fluid peritoneal shunting. Weight reduction surgery provides patients who are obese with a multitude of benefits and it is not uncommon for the general surgeon to be presented with a patient with idiopathic intracranial hypertension and a cerebrospinal fluid peritoneal shunt in place. This provides a potential challenging situation in weight-loss surgical procedures. We describe an interesting case where laparoscopic bariatric surgery resulted in transection of the abdominal catheter with a delayed presentation of recurrent symptoms and an abdominal cerebrospinal fluid collection in a patient with idiopathic intracranial hypertension. We discuss how this could be avoided and its management.

CSF-diverting shunts: Implications for abdominal and pelvic surgeons; a review and pragmatic overview

“…The location of the tip of the shunt as well as the presence or absence of a valve are relevant considerations during abdominal surgery. Lack of awareness of the shunt tip may lead to accidental shunt transection or damage, while lack of awareness of the shunt valve may affect intraoperative CSF drainage [1]. The proximal end of the VP shunt is placed in the lateral ventricle and tunnelled subcutaneously.…”