Right upper quadrant abdominal pain due to malposition of the tip of the distal catheter of ventriculoperitoneal shunt

Abstract

There are few reports about abdominal pain due to shunt malposition which have been located in right lower quadrant. In this case, we reported a 17-years old boy with history of medulloblastoma surgery and shunt insertion who had severe abdominal pain especially in right upper quadrant without any history of fever, nausea and vomiting and any symptoms of ICP rising. Physical examination revealed a moderate tenderness on the right upper quadrant, but rebound tenderness was absent. Laboratory data including CSF analysis were normal. Plain abdominal films showed the tip of the catheter in the right upper quadrant. Abdominal ultrasound showed a very mild collection at entrance site of shunt in peritoneal cavity. After exploration, there was not any surgical finding. The only thing that could explain the abdominal pain, was location of the tip of distal catheter toward the liver around the falciform ligament. The distal catheter was exited and repositioning performed. After surgery, the abdominal pain of the patients was relieved dramatically. After one year follow up, the patient has not any problem with his shunt. Keywords: Shunt malposition, Abdominal Pain, Ventriculoperitoneal shunt