Chemical meningitis from bile reflux in a lumbar-gallbladder shunt

Objective and Importance: The gallbladder is used to divert cerebrospinal f luid (CSF) in patients with hydrocephalus when all other sites have been ex hausted. This is seen in hydrocephalic patients who have reached teenage ye ars but have undergone multiple shunt revisions, abdominal operations and r epeated neck vein cannulations during childhood. One complication of the lu mbar-gallbladder shunt is discussed as well as its pathophysiologic theory and management, Clinical Presentation: A case of a patient with a lumbar-ga llbladder shunt who developed chemical meningitis from reflux of bile into the CSF space is presented. The patient presented with generalized seizures . Intervention: Included: ventilatory support, externalization of the shunt , correction of the metabolic abnormalities and administration of anticonvu lsants and steroids. Conclusion: This case illustrates an unusual occurrenc e of reflux of bile into the CNS through a lumbar-gallbladder shunt in a pa tient with long-term complex communicating hydrocephalus, It also demonstra tes its mode of presentation and successful management. To our knowledge, t his is the first case report of its kind.