An Atypical Presentation of Pancreatitis Secondary to a Ventriculoperitoneal Shunt.

Ventriculoperitoneal (VP) shunts are catheters inserted to drain excess cerebrospinal fluid (CSF) when there is an obstruction in the normal outflow or a decreased absorption of the fluid leading to hydrocephalus. Recognised complications of placement of the distal catheter are malposition, obstruction, pseudocysts and infection. Here, we present a case of a 23-year-old female with acute pancreatitis following the placement of a VP shunt in the lesser sac. The patient originally had a VP shunt placed in infancy for congenital hydrocephalus with one revision at four years old. She presented with a three-day history of worsening epigastric pain with an associated lipase of 3030 (10-60IU), CRP 157 (<5mg/L) and normal liver function tests. A CT scan showed acute pancreatitis with an associated collection within the lesser sac extending to the greater omentum. This was due to the malposition of the VP shunt after a recent revision surgery. It was managed with a diagnostic laparoscopy, washout and shunt externalisation. This is an atypical presentation of acute pancreatitis secondary to a VP shunt. A high index of suspicion is needed for diagnosis. Management of both pancreatitis and VP shunt complications need to be considered.

Major lower limb amputations in Far North Queensland.

BACKGROUND: Major lower limb amputation is a devastating operation most commonly performed for complications of peripheral artery disease or diabetes mellitus. Data suggest that there is a widespread variation in major amputation rates within and between countries. This study aimed to identify key characteristics of patients undergoing this procedure in our region, and to compare our population to the rest of Australia. Secondary analysis was performed to assess differences seen in the Indigenous population. METHODS: Cases were identified from a prospectively maintained database and medical records were retrospectively reviewed to record relevant clinical information. A literature review was then undertaken to compare our data to other series. RESULTS: A total of 51 major lower limb amputations were performed between January 2015 and January 2017, and the mean age of patients was 59.5 years. Over 70% of patients were diabetic, and one-third required dialysis. Twenty-three patients were identified as Indigenous, and they were significantly younger (54.6 ± 11.4 versus 63.5 ± 15.9 years, P = 0.02) and more likely to be diabetic (91.3% versus 65.2%, P ≤ 0.01) compared to non-Indigenous patients. The most common indication was arterial ulcer or gangrene (52.9%), but Indigenous patients were more likely to have amputation due to sepsis (47.8% versus 7.1%, P < 0.01). CONCLUSION: Patients undergoing major amputation in Far North Queensland are more likely to be younger and diabetic than Queensland or Australian counterparts. Diabetes and renal disease were especially prevalent in our cohort, with higher rates found in Indigenous patients.