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Updated: May 16, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Management of abdominal pseudocyst in shunt-dependent hydrocephalus
Sung-Joo Yuh1, Michael Vassilyadi
1Division of Neurosurgery, The Ottawa Hospital, University of Ottawa, Canada.
Insights
Abdominal pseudocyst (APC) is a rare complication of ventriculoperitoneal (VP) shunts, often linked to inflammation or infection. Management involves fluid drainage and shunt revision, as demonstrated in a case study.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Complications
Background:
- Abdominal pseudocyst (APC) is an infrequent complication associated with ventriculoperitoneal (VP) shunts.
- It typically arises from an inflammatory response, frequently triggered by infection.
Observation:
- A 13-year-old girl with a history of VP shunt for congenital hydrocephalus presented with symptoms of abdominal distention, pain, and vomiting.
- Imaging revealed large, multiseptated cysts, and 1.8 L of sterile, xanthochromic fluid was drained.
- The patient underwent shunt externalization, antibiotic treatment, and subsequent revisions, including conversion to a ventriculoatrial system.
Findings:
- APC can manifest years after initial shunt surgery, with an unclear etiology.
- The cerebrospinal fluid analysis showed no signs of infection.
- Successful management involved fluid drainage and shunt system modification.
Implications:
- This case highlights APC as a significant complication of VP shunts requiring careful management.
- Early recognition and appropriate surgical intervention are crucial for favorable outcomes.
- Further research into the etiology and optimal treatment strategies for APC is warranted.
Background:
Abdominal pseudocyst (APC) is an uncommon manifestation of a ventriculoperitoneal (VP) shunt that is attributed to an inflammatory response, usually the result of infection.
Case Description:
A 13-year-old girl with a VP shunt presented with progressive abdominal distention, pain and vomiting. The shunt was inserted at infancy for congenital hydrocephalus. A shunt infection was treated with externalization of the shunt, antibiotics and subsequent shunt replacement. At the age of four, the shunt was revised for a distal malfunction. Nine years later, abdominal CT and ultrasound demonstrated large multiseptated cysts. The shunt was externalized and 1.8 L of sterile, xanthochromic peritoneal fluid was drained. The cerebrospinal fluid was clear, colorless, acellular and sterile with normal protein and glucose levels. Two days later, the distal portion of the shunt was replaced back into the pleural cavity. Five months later a pleural effusion formed. Thoracentesis was performed and there was no evidence of infection. The shunt was subsequently converted to a ventriculoatrial system. The patient has remained well for over 3.5 years.
Conclusion:
APC represents an important complication of VP shunts, with an unclear etiology that can occur nine years after shunt surgery. This paper presents an update on the management of APCs.
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