Abdominal cerebrospinal fluid pseudocyst occurring 21 years after ventriculoperitoneal shunt placement: a case report

Abstract

Background: Ventriculoperitoneal shunt (VPS) placement is an established procedure for the treatment of hydrocephalus of diverse etiologies in children and adults. Abdominal cerebrospinal fluid pseudocyst, which is potentially life threatening, is a rare complication and usually occurs during childhood. However, with increasing longevity following successful treatment, it can also occur in adults.

Case presentation: Here we describe a 22-year-old man who was admitted to our hospital because of diffuse abdominal distention. A VPS was placed 21 years earlier to treat hydrocephalus secondary to spina bifida. Abdominal computed tomography (CT) revealed a homogeneous low-density fluid collection adjacent to the VPS catheter tip, causing stomach obstruction. Thus a peritoneal pseudocyst around VPS was suspected and emergency laparotomy was performed. The large mass was localized in the left upper abdomen between the stomach and mesentery of the transverse colon, exactly at the omental bursa. The cystic mass was opened and 1500 ml of clear fluid was drained; the distal end of the VPS was repositioned outside the mass. Thus, an abdominal cerebrospinal fluid pseudocyst as a complication of VPS was diagnosed.

Conclusion: Gastroenterological surgeons should be aware of this possible complication, and this complication should be considered during differential diagnosis of an acute abdomen complaint.

Figure 1

Abdominal radiography showing the VPS catheter and a soft-tissue mass located in the upper abdomen.

Figure 2

Abdoinal CT (A: axial, B: sagital) showing the fluid collection adjacent to the VPS catheter tip. A,B Abdominal CT showing the fluid collection adjacent to the VPS catheter tip.

Figure 3

Intraoperative finding presenting a large mass located at the omental bursa.

Figure 4

Intraoperative finding presenting the inner cavity of the pseudocyst. Wall of the pseudocyst consisted of the posterior wall of stomach (arrow) and colonic mesentery.