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Sterile cerebrospinal fluid ascites presenting as high SAAG ascites: a case report
Darrick K Li1, Jesse M Platt2, Jessica E S Shay2
1Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Blake Building, 4th Floor, GI Unit, Boston, MA, 02114, USA. dkli@partners.org.
BMC Gastroenterology
|November 29, 2019
Summary
Sterile cerebrospinal fluid ascites, a rare complication of ventriculoperitoneal shunts, can mimic portal hypertension. A peritoneovenous shunt offers a novel treatment for this unusual condition.
Area of Science:
- Neurosurgery
- Gastroenterology
- Nephrology
Background:
- Cerebrospinal fluid (CSF) ascites is a rare complication of ventriculoperitoneal (VP) shunting.
- It is most often caused by infection and peritonitis.
- Sterile CSF ascites without an identified infectious cause is exceptionally uncommon.
Observation:
- A 26-year-old female with Loeys-Dietz syndrome and hydrocephalus developed new-onset ascites post-aortic aneurysm repair.
- Ascites showed a high serum-ascites albumin gradient (SAAG), suggesting portal hypertension.
- Extensive investigations, including hepatic venous portal gradient measurement and liver biopsy, ruled out hepatic disease or portal hypertension.
Findings:
- The patient was diagnosed with sterile CSF ascites.
- This condition is a rare cause of high SAAG ascites, with fewer than 50 reported cases.
- Treatment with a peritoneovenous shunt was successful.
Implications:
- Sterile CSF ascites is a rare but important differential diagnosis in patients with ascites and a history of VP shunting.
- High SAAG ascites can occur in the absence of portal hypertension.
- Peritoneovenous shunting represents a potential therapeutic strategy for managing sterile CSF ascites.
