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Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report
Yasuhiro Koide1,2, Takaaki Osako1, Masahiro Kameda3
1Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Insights
Cerebrospinal fluid (CSF) pseudocysts can develop in the abdomen of patients with ventriculoperitoneal shunts. This case report details a successful treatment for a large abdominal CSF pseudocyst in a pediatric patient.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Gastroenterology
Background:
- Ventriculoperitoneal shunts are used to treat hydrocephalus.
- Abdominal cerebrospinal fluid (CSF) pseudocysts are a rare complication of ventriculoperitoneal shunts.
Observation:
- A 12-year-old boy with a ventriculoperitoneal shunt presented with altered consciousness and a large abdominal mass.
- Imaging revealed a large abdominal CSF collection near the shunt's distal catheter tip and enlarged ventricles.
Findings:
- The patient underwent successful management involving externalization of the shunt catheter, percutaneous aspiration of the pseudocyst, and eventual reinsertion of the shunt.
- This approach resolved the abdominal pseudocyst and improved the patient's neurological status.
Implications:
- Emergency physicians should consider abdominal CSF pseudocysts in patients with ventriculoperitoneal shunts presenting with acute abdominal symptoms.
- Prompt diagnosis and appropriate management are crucial for favorable outcomes in this rare complication.
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.
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