Severe hydronephrosis caused by an infected intra-abdominal fluid collection in a patient with a ventriculoperitoneal shunt

Abstract

The authors report a case of a 10-year-old boy with myelodysplasia and shunted hydrocephalus who developed acute severe hydronephrosis presumed secondary to a large abdominal cerebrospinal fluid (CSF) collection. The patient had recently begun having trouble catheterizing his Monti channel, and had been diagnosed and treated for an Escherichia Coli urinary tract infection. He presented with abdominal pain, and an abdominal CT demonstrated severe hydronephrosis and a large abdominal fluid collection presumed to be a CSFoma. The shunt was externalized, and fluid consistent with CSF was removed by aspiration of the shunt catheter at the time of surgery and by interventional radiology placement of a pigtail drain into the remaining fluid collection. Endoscopic evaluation of the Monti channel revealed evidence of healed perforation. A suprapubic catheter was placed and the Monti channel remained catheterized. The shunt was eventually converted to a ventriculoatrial shunt. A postoperative renal ultrasound later demonstrated marked improvement in the hydronephrosis and mild caliectasis. The suprapubic catheter and the indwelling Monti catheter were removed. The patient resumed catheterization of the Monti channel. Follow-up ultrasounds have shown stable, mild hydronephrosis, consistent with the patient's baseline. Practitioners should have a high index of suspicion for potential shunt contamination and CSFoma development in patients with Monti channels and a history of difficult catheterization.