Photoclinic Diagnosis: Protrusion of Peritoneal Part of VP Shunt Catheter from Umbilicus

Anewborn female was brought to the Neurosurgical Clinic of Taleghani Hospital with an irregular mass in the lower back. On clinical examination the sac was found to be 5x6 cm in size and tense on palpation. The patient was born 6 days before the expected date of confinement (EDC). The head was grossly enlarged with a circumference of 49 cm. The fontanel was bulging and fully obliterated with completely split sutures and dilated veins on thin scalp. She had sunset eyes and paraplegia of the lower extremities. Brain CT scan revealed huge hydrocephalus. The patient was scheduled for a ventriculoperitoneal (VP) shunt. A right frontal catheterization was performed for entry to the ventricle. Peritoneal insertion was done through a skin incision about 5 cm below the costal margin in the right upper quadrant. Two days after operation, there was a marked reduction in the fontanel tension and a shrinkage in the myelomeningocele sac size and all the signs and symptoms of raised intracranial pressure (RICP) disappeared.