PMC5299151_01
Postoperative abdominal X-ray film following the patient's second shunt revision demonstrating appropriate shunt placement. As noted, the peritoneal portion was placed laparoscopically by general surgery and was visualized to be within the peritoneal space
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F1
He underwent another VPS revision with placement of a new right frontal VPS shunt and a new distal peritoneal catheter placed laparoscopically by the general surgery team [Figure 1].
Initial evaluation in the emergency department demonstrating shunt catheter placement in the abdomen, which was originally interpreted as intraperitoneal
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F2
At this initial emergency room evaluation, his rectal exam was unremarkable; on shunt series X-rays, the distal catheter was within the peritoneal cavity [Figure 2].
(a) Abdominal shunt series X-ray showing the distal peritoneal catheter protruding through the rectum (arrow), and (b) abdominal computed tomography showing the distal peritoneal catheter within the bowel (arrow)
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F3
X-rays corroborated the physical exam [Figure 3a]; CT imaging clearly revealed the distal peritoneal catheter within the large colon and rectum [Figure 3b].