From shunt to gut: managing a ventriculoperitoneal shunt-associated abdominal pseudocyst causing bowel obstruction -...

Abdominal cerebrospinal fluid pseudocysts (APCs) are a rare complication of ventriculoperitoneal (VP) shunts, occurring in 1-4.5% of cases and potentially causing abdominal symptoms, bowel obstruction, or shunt malfunction. We present a case of a VP shunt-associated pseudocyst leading to mechanical small bowel obstruction.

A 40-year-old woman with a long-standing VP shunt presented with abdominal pain, vomiting, and obstipation. CT imaging showed a large pseudocyst encasing the shunt tip and causing mechanical ileus. Emergency surgery revealed adhesion-related small-bowel obstruction, requiring partial cystectomy and ileal resection. cerebrospinal fluid (CSF) cultures grew Cutibacterium acnes, prompting complete shunt removal, external ventricular drainage, and later placement of a ventriculoatrial shunt. She recovered with conservative management of minor postoperative complications.

APCs may form due to impaired CSF absorption, inflammation, or low-grade infection. In this patient, a chronic shunt infection likely contributed to cyst development and bowel obstruction. Management typically requires cyst drainage or resection, and revision of the distal catheter, with complete shunt removal necessary when infection is present. Early diagnosis and multidisciplinary management are essential to prevent morbidity.

VP shunt-associated pseudocysts, though rare, can cause acute abdominal emergencies. Prompt imaging, surgical intervention, and appropriate treatment of shunt infection are critical for optimal outcomes.