P.140 Illustrated case report: CSF shunt peritoneal catheter obstruction due to omental adhesion and fat stranding

Abstract

Background: CSF shunt obstruction secondary to omental adhesion alone, without cyst or pseudocyst formation, is rarely reported in the literature. Here we present a case of distal catheter obstruction due to omental wrapping with an atypical presentation of shunt failure. CT imaging demonstrated omental stranding. The shut revision was entirely laparoscopic. The case is supplemented with intraoperative images. Methods: Chart review and literature search. Results: 33-year-old female with right-sided cystoperitoneal shunt for posterior fossa arachinoid cyst who presented to ED with a picture of a surgical abdomen suggestive of acute cholecystitis. Interestingly, this patient had a gallbladder removed a year ago. CT abdomen showed non-specific findings of omental fat stranding around the tip of the catheter. Although this patient had no headache or any neurological symptoms, CT brain was done and showed increase in the cyst size. Diagnostic laparoscopy showed Intraoperative findings suggestive of active omental role in the aetiology of this shunt malfunction. After adequate adhesiolysis, the catheter was noted to be working and dripping CSF and repositioned into the peritoneal cavity. Conclusions: Shunt malfunctions due to omentoperitoneal adhesion is rarely reported but may in fact be under-recognized. This requires high index of suspicion especially in case of equivocal imaging.