RESUMEN
The authors report the case of 14-year-old girl with a history of myelomeningocele and previously shunt-treated hydrocephalus who presented with right-sided abdominal pain and subcutaneous emphysema that developed over a 1-week period. A CT scan of the patient's abdomen revealed a retained distal ventriculoperitoneal (VP) catheter with air tracking from the catheter to the upper chest wall. Given the high suspicion of the catheter being intraluminal, an exploratory laparotomy was performed and revealed multiple jejunal perforations. The patient required a partial small-bowel resection and reanastomosis for complete removal of the retained catheter. Six other similar cases of bowel perforation occurring in patients with abandoned VP and subdural-peritoneal shunts have been reported. The authors analyzed these cases with regard to age of presentation, symptomatic presentation, management, morbidity, and mortality. While there was 0% mortality associated with bowel perforation secondary to a retained distal VP catheter, the morbidity was significantly high and included peritonitis and small bowel resection.
Asunto(s)
Dolor Abdominal/etiología , Catéteres de Permanencia/efectos adversos , Migración de Cuerpo Extraño/complicaciones , Perforación Intestinal/etiología , Enfisema Subcutáneo/etiología , Derivación Ventriculoperitoneal/efectos adversos , Dolor Abdominal/diagnóstico por imagen , Dolor Abdominal/cirugía , Adolescente , Diagnóstico Diferencial , Femenino , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/cirugía , Humanos , Hidrocefalia/cirugía , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/cirugía , Meningomielocele/cirugía , Enfisema Subcutáneo/diagnóstico por imagen , Enfisema Subcutáneo/cirugía , Tomografía Computarizada por Rayos X , Derivación Ventriculoperitoneal/instrumentaciónRESUMEN
We report a rare case of Mycobacterium haemophilum presenting as an intraventricular granulomatous mass with loculated hydrocephalus and seizures in a patient with human immunodeficiency virus. M. haemophilum, a slow-growing mycobacteria, causes localized and disseminated disease among immunocompromised hosts. Central nervous system infection with M. haemophilum is extremely rare. Preoperative laboratory testing of our patient for tuberculosis, toxoplasmosis, sarcoidosis and histoplasmosis were negative. Surgical resection of the mass revealed a caseating granuloma that stained positive for acid-fast bacillus suggesting possible tuberculoma. Despite negative testing for tuberculosis, a polymerase chain reaction analysis was ultimately performed from the resected mass which revealed M. haemophilum. To our knowledge, this is the first case of M. haemophilum presenting as an intraventricular mass. We review the clinical manifestations of this pathogen and discuss the medical and surgical management.