PMC8571190_01
In the region indicated by the red circle, a fatty densification can be noted indicating an infectious process arising from the abscess in the left flank.
SNI-12-525-g001.jpg
PMC8571190_01_SNI-12-525-g001.jpg
F1
About 2 months after this incident, there was an alteration in the catheter's trajectory, with the formation of an abscess in the left flank [Figure 1], which later fistulized to the external environment [Figure 2].
Pustular collection due to abscess formed by fistulization of the catheter to the external environment.
SNI-12-525-g002.jpg
PMC8571190_01_SNI-12-525-g002.jpg
F2
About 2 months after this incident, there was an alteration in the catheter's trajectory, with the formation of an abscess in the left flank [Figure 1], which later fistulized to the external environment [Figure 2].
CT scan image showing a VPS catheter with a guided pathway in the subcutaneous left anterior abdominal wall.
SNI-12-525-g003.jpg
PMC8571190_01_SNI-12-525-g003.jpg
F3
At the time, examinations were performed, among which an abdominal CT scan revealed hyperdensity in subcutaneous cellular tissue and muscles of the left flank, as well as an anomalous distal catheter path in the retroperitoneal region [Figures 3-5].
CT scan image showing internalization of the catheter (red arrows) into the abdominal cavity at the level of the mesogastrium, followed by the anterolateral face into the peritoneal cavity on the left, and with the distal part permeating the transverse abdominal and oblique muscles.
SNI-12-525-g004.jpg
PMC8571190_01_SNI-12-525-g004.jpg
F4
At the time, examinations were performed, among which an abdominal CT scan revealed hyperdensity in subcutaneous cellular tissue and muscles of the left flank, as well as an anomalous distal catheter path in the retroperitoneal region [Figures 3-5].
CT scan image showing the catheter pathway (red arrows) from the left anterior abdominal wall to the subcutaneous left flank posterolateral wall, where displays fatty densification (blue arrow), suggesting a locoregional inflammatory process.
SNI-12-525-g005.jpg
PMC8571190_01_SNI-12-525-g005.jpg
F5
At the time, examinations were performed, among which an abdominal CT scan revealed hyperdensity in subcutaneous cellular tissue and muscles of the left flank, as well as an anomalous distal catheter path in the retroperitoneal region [Figures 3-5].
Soft-tissue ultrasound image: skin and subcutaneous tissue presenting focal discontinuity of their planes, with associated inflammatory edema, forming an elongated pertum measuring about 4.2 cm depth x 0.7 cm in diameter and with apparent contiguity with the abdominal cavity. The echogenic linear image permeating the pertum may correspond to the shunt catheter with distal part subjacent to the skin.
SNI-12-525-g006.jpg
PMC8571190_01_SNI-12-525-g006.jpg
F6
A soft-tissue ultrasound was also performed identifying, in the upper lumbar trigone, a muscle herniation (Grynfeltt hernia) [Figure 6].
Scar from Penrose drain.
SNI-12-525-g007.jpg
PMC8571190_01_SNI-12-525-g007.jpg
F7
The abdominal region was left with a Penrose drain [Figure 7] and the tip of the distal catheter was sent to culture as well as the fluid collected in the thoracic part of the catheter.
Picture taken of the patient's back showing, in sequence: the scar from the catheter's coverage in the subcutaneous region, the two scars resulted by the dermal-epidermal atrophy at the center, and, finally, the scar from the VPS surgery.
SNI-12-525-g008.jpg
PMC8571190_01_SNI-12-525-g008.jpg
F8
He was discharged after 5 days of hospitalization, with only a few scars in the thoracic-abdominal level [Figure 8].