Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

This young woman had myelomeningocele with a VP shunt and neurogenic dysfunction of her bladder.  She has had a fascial sling and augmentation of her bladder with stomach (gastrocystoplasty) and is on clean intermittent catheterization.  She presented recently, many years after gastrocystoplasty, with fever, abdominal pain, shortness of breath, and decreased urine output on catheteriztion.  A CT scan showed a large amount of fluid in the abdomen, much more than is usually seen in a patient with a VP shunt and only CSF in the peritoneal cavity (Figure 1).  A cystogram showed extravasation from the augmented bladder (Figure 2).  At operation she was found to have two perforations in the augmenting piece of the stomach.