Pseudocyst of Abdomen Presenting as a Huge Abdominal Mass after Ventriculoperitoneal Shunt: A Case Report

A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter. In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst. Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.

Removal of the Retained Ventricular Catheter Using the Endoscopic Monopolar Instrument

Background. Ventriculoperitoneal shunt (VPS) remains the main treatment for hydrocephalus. However, VPS revision surgery is very common. Here, we present a case in which the retained ventricular catheter was removed using the endoscopic monopolar instrument. Methods. We report a case of a 28-year-old female who presented with VPS obstruction. She had two previous shunt revision surgeries due to shunt obstruction. Eleven years after the last one, she presented an abdominal pseudocyst that indicated a total system removal. During VPS revision surgery, a retained ventricular catheter was observed. The endoscopic monopolar instrument was introduced into the retained catheter under direct view. Coagulations in a back-and-forth movement were applied to release inner catheter adhesions. After these steps, the catheter was removed, and a new one was placed through the same route. Results. The catheter was removed without complications, confirmed by the postoperative cranial computed tomography. The patient remained asymptomatic. Conclusion. The described technique was effective and avoided ventricular bleeding. Further studies are necessary to validate this method.

Risk factors for unchanged ventricles during pediatric shunt malfunction

OBJECTIVE Children whose ventricles do not change during shunt malfunction present a diagnostic dilemma. This study was performed to identify risk factors for unchanged ventricular size at shunt malfunction. METHODS This retrospective 1:1 age-matched case-control study identified children with shunted hydrocephalus who underwent shunt revision with intraoperative evidence of malfunction at one of the three participating institutions from 1997 to 2019. Cases were defined as patients with a change of < 0.05 in the frontal–occipital horn ratio (FOR) between malfunction and baseline, and controls included patients with FOR changes ≥ 0.05. The presence of infection, abdominal pseudocyst, pseudomeningocele, or wound drainage and lack of baseline cranial imaging at the time of malfunction warranted exclusion. RESULTS Of 450 included patients, 60% were male, 73% were Caucasian, and 67% had an occipital shunt. The median age was 4.3 (IQR 0.97–9.21) years at malfunction. On univariable analysis, unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p < 0.001), programmable valve (17% vs 9%, p = 0.011), nonsiphoning shunt (85% vs 66%, p < 0.001), larger baseline FOR (0.44 ± 0.12 vs 0.38 ± 0.11, p < 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt revisions (68% vs 52%, p < 0.001). On multivariable analysis with collinear variables removed, patients with a frontal shunt (OR 1.67, 95% CI 1.08–2.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32–5.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63–4.67, p < 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21–4.43, p < 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27–4.30, p = 0.007) were more likely to have unchanged ventricles at malfunction. CONCLUSIONS In a multicenter cohort of children with shunt malfunction, those with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure.

VENTRICULO PERITONEAL SHUNT WITH ABDOMINAL PSEUDOCYST – MANAGEMENT, A CASE SERIES STUDY.

Hydrocephalus is the excess accumulation of cerebral spinal uid. The appropriate management option for an individual still remains a dilemma in many situations. We discuss a case series of 10 patients with who presented with abdominal pseudocyst, to arrive at a conclusion which treatment option will be best for the individual

Management strategies for giant abdominal pseudocyst in a patient with ventriculoperitoneal shunt

Ventriculoperitoneal (VP) shunt is considered as the mainstay treatment of hydrocephalus, it remains as one of the most failure prone surgical interventions worldwide. Abdominal pseudocyst (APC) is one of the rare complications of VP shunt and is more prevalent in paediatric population. In this case, the patient is an 11-year-old male with history of tubercular meningitis with hydrocephalus for which VP shunt was done and the patient developed a giant abdominal pseudocyst which is the 3rd largest pseudocyst reported till date in a paediatric patient known best to our knowledge. This case is particularly unique due to rapid development of such a large pseudocyst in a span as short as 6 weeks. In this article, the causes of formation of APC and the treatment protocol to manage the patient with abdominal pseudocyst secondary to VP shunt are also discussed.

Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

Background Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far. Case presentation This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up. Conclusion To the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

Ultrasound-guided percutaneous aspiration of abdominal pseudocyst following ventriculoperitoneal shunt implantation in a child: A case report

Pseudocyst is a rare complication of ventriculoperitoneal shunt (VPS) seen in 1–4% of pediatric age group and it’s usually managed by surgical excision. We report a new case of cerebrospinal fluid pseudocyst complicating VPS that was managed by percutaneous aspiration resulting in a successful outcome. A 2-year-old male presented with fever, abdominal pain, diarrhea, and vomiting. Abdomen examination showed palpable tender epigastric mass. Ultrasound examination and CT scan of the abdomen demonstrated localized epigastric fluid collection. He was managed with IV antibiotics, shunt externalization, and percutaneous aspiration of the pseudocyst. On follow-up examination, no similar symptoms were recorded. Percutaneous aspiration is a more conservative and effective approach in managing VPS pseudocyst in the new era of interventional radiology. Although the occurrence of abdominal pseudocyst is rare, a high index of suspicion should be maintained to avoid the risk of ascending infection.