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

摘要

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.