A bullous surprise: A rare VP shunt complication

Abstract

We report a rare case of subcutaneous cerebrospinal fluid loculations, or bullae, along the anterior abdominal wall following ventriculoperitoneal shunt in an 8-year-old female with a history of tubercular meningitis and hydrocephalus. The patient presented with headache, nausea, and two soft, transilluminated swellings on the right side of her abdomen, three years after initial shunt placement and subsequent revision for peritoneal end malfunction. Imaging revealed gross ventriculomegaly and anterior parietal wall collections along the shunt tract. Intraoperatively, loculated CSF collections were found near the abdomen, and the lower end of the shunt was revised. Fluid analysis confirmed CSF composition. The patient recovered well postoperatively with resolution of ventriculomegaly and was discharged on prophylactic antibiotics. Subcutaneous CSF loculations in the anterior abdominal wall represent a unique and previously undocumented complication of VP shunts. Potential mechanisms include protracted CSF drainage, tissue plane dissection secondary to elevated intra-abdominal pressure, or catheter misplacement, exacerbated by prior abdominal surgeries and adhesions. This case highlights the importance of considering rare presentations of shunt malfunction and the need for thorough clinical and radiological evaluation. Early diagnosis and prompt surgical intervention, typically shunt revision, are crucial for effective management and improved patient outcomes.