Abdominal cerebrospinal fluid pseudocyst mimicking full-term pregnancy

Ventriculoperitoneal shunt-associated abdominal cerebrospinal fluid pseudocysts and the role of laparoscopy and a proposed management algorithm in its treatment. A report of 2 cases

Abdominal cerebrospinal fluid pseudocyst (APC) is a rare complication associated with a ventriculoperitoneal shunt (VPS) placement. Abdominal cerebrospinal fluid pseudocyst is defined as a cyst surrounded by a non-epithelial lining and filled with the cerebrospinal fluid (CSF). In general, 1% - 4.5% of all patients treated with a VPS develop CSF pseudocysts. Here, we have presented 2 cases of APC complicating VPS placement and a proposed treatment management algorithm. The cases pertained to 7-year-old and 5-year-old children who had undergone VPS placement during infancy and presented with progressive abdominal distention and vomiting and fever, respectively. Both cases were assessed using similar investigations and imaging modalities and diagnosed with APC. However, the treatments were individually tailored based on the algorithm; successful outcomes were achieved in both patients. Abdominal cerebrospinal fluid pseudocyst treatment is difficult considering the presence of adhesions and infection and is associated with a high recurrence rate.

Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report

Introduction

Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst.

Case presentation

A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management.

Conclusion

Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.

Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure

PURPOSE

The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure.

METHODS

We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children's Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified.

RESULTS

Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6).

CONCLUSION

The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.

Intraperitoneal cerebrospinal fluid pseudocyst with ventriculoperitoneal shunt

Ventriculoperitoneal (VP) shunting is mostly used in the treatment of hydrocephalus and many complications have been reported with this method. Abdominal Pseudocyst (APC) are relatively uncommon but important complications in patients with VP shunts. We herein report the case of a 9-year-old boy with VP shunt who presented with abdominal distension, abdominal pain, malaise, and decrease of appetite. Abdominal pelvic computed tomography confirmed a diagnosis of APC. Laparotomy was done and VP shunt was placed into the other side of peritoneal cavity again. Also here, etiology, presentation, diagnosis, and treatment of APC were reviewed.