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Abdominal cerebrospinal fluid pseudocyst in a severely handicapped patient with hydrocephalus
M Horikawa1, T Yamada, K Tominaga
1Department of Pediatrics, National Higashi-Saga Hospital, Saga, Japan. mizuho@esaga.hosp.go.jp
Insights
Abdominal cerebrospinal fluid pseudocysts are a rare complication of ventriculoperitoneal shunts. Consider this diagnosis and use abdominal ultrasonography for shunt dysfunction evaluation.
Area of Science:
- Neurology
- Neurosurgery
- Pediatric Surgery
Background:
- Ventriculoperitoneal shunts are used to treat hydrocephalus.
- Shunt complications can include disconnection and dysfunction.
- Cerebrospinal fluid pseudocysts are an uncommon but serious complication.
Observation:
- A severely handicapped, bedridden patient with spastic quadriplegia and hydrocephalus underwent shunt tube reconstruction.
- Post-surgery, the patient developed fever, vomiting, and severe abdominal fullness.
- Abdominal ultrasonography revealed an abdominal cerebrospinal fluid pseudocyst.
Findings:
- The patient's symptoms were attributed to an abdominal cerebrospinal fluid pseudocyst.
- This diagnosis was made following shunt tube reconstruction for disconnection.
- Ultrasonography proved effective in identifying the pseudocyst.
Implications:
- Abdominal cerebrospinal fluid pseudocysts should be considered in patients with suspected shunt dysfunction.
- Abdominal ultrasonography is a valuable screening tool for diagnosing this complication.
- Early diagnosis and management are crucial for patients with hydrocephalus and shunt systems.
Abstract:
We present a case of an abdominal cerebrospinal fluid pseudocyst as a rare complication of a ventriculoperitoneal shunt. The patient is a severely handicapped bedridden spastic quadriplegic with hydrocephalus. He underwent surgical reconstruction of a shunt tube because of shunt disconnection at the age of 12 years. Fever and frequent vomiting developed 2 months after surgery, and abdominal fullness gradually became severe. He was diagnosed as having an abdominal cerebrospinal fluid pseudocyst on abdominal ultrasonography. If a shunt dysfunction is suspected, this type of cyst should also be considered, and abdominal ultrasonography should be performed as one of the screening tests for determining the cause of the shunt dysfunction.