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Ventriculo-peritoneal shunt pseudocyst causing ureteropelvic junction obstruction in a child with myelomeningocele
Insights
A boy with myelomeningocele and a shunt developed a pseudocyst causing ureteropelvic junction obstruction. This rare case highlights upper urinary tract complications from shunts and a retrocaval ureter in myelomeningocele.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Urology
Background:
- Myelomeningocele is a complex congenital condition often requiring interventions like cerebrospinal fluid shunts.
- Ventriculo-peritoneal shunts are common in managing hydrocephalus associated with myelomeningocele.
- Upper urinary tract obstruction can lead to significant renal complications.
Observation:
- A patient with myelomeningocele and a ventriculo-peritoneal shunt presented with progressive ureteropelvic junction obstruction.
- An enlarging right upper quadrant mass was noted.
- Surgical exploration revealed a large pseudocyst surrounding the distal shunt.
Findings:
- The pseudocyst caused obstruction of an unsuspected retrocaval ureter.
- This represents the first reported instance of upper urinary tract complication secondary to a ventriculo-peritoneal shunt.
- It is also the first reported association of a retrocaval ureter with myelomeningocele.
Implications:
- This case underscores the potential for rare complications arising from ventriculo-peritoneal shunts.
- It highlights the importance of considering genitourinary anomalies in patients with myelomeningocele.
- Awareness of this association may improve diagnostic and management strategies for similar cases.
Abstract:
We report on a boy with myelomeningocele and a ventriculo-peritoneal shunt, who presented with progressive ureteropelvic junction obstruction and an enlarging right upper quadrant mass. Exploration revealed a large pseudocyst around the distal portion of the shunt, causing obstruction of an unsuspected retrocaval ureter. To our knowledge this is the first reported case of an upper urinary tract complication due to a ventriculo-peritoneal shunt as well as the first case of a retrocaval ureter associated with myelomeningocele.