A 59-year-old man, who had a ventriculoperitoneal shunt (VPS) operation for the treatment of hydrocephalus due to cysticercosis 26 years prior, visited our hospital with increasing abdominal distention. An abdominal computed tomography (CT) scan showed well enhanced demarcated fluid collection about 20×18 cm around the distal catheter tip. We performed exploratory laparoscopy and inserted a drainage catheter into the abdominal cyst. All cyst fluid analyses and cultures were negative. Over the course of the next eight weeks, abdominal CT demonstrated that the pseudocyst decreased. Following removal of the drainage catheter, abdominal CT showed that the pseudocyst increased again. A drainage catheter was re-inserted and Taurolin ® (Taurolidine) solution irrigation was performed for 3 months. Upon the completion of this 3 months, the patient complained of abdominal distension and abdominal CT found both that the pseudocyst was increased and doubted cystic infection. Eventually, an exploratory laparotomy and cyst resection were performed. Although the occurrence of pseudocyst following VPS surgery is a rare complication, it can cause additional complications such as obstruction and infection. If a patient has gastrointestinal symptoms, pseudocyst should be considered as one of the complications of VPS surgery.
Chronic or shunt-dependent hydrocephalus (SDH) is a hydrocephalus that develops at two weeks or more after onset of subarachnoid hemorrhage (SAH). A recent study has reported that lumbar drainage (LD) can reduce the incidence of SDH after coil embolization of aneurysmal SAH, different from previous studies. The purpose of this study was to determine the effect of LD on incidence of SDH after SAH in patients who underwent coil embolization. Methods: A total of 113 patients who were treated with coil embolization only for SAH from January 2006 to August 2013 were investigated. They were randomly allocated into two groups depending on the management protocol that included LD insertion or not. SDH was defined based on Evans index and bicaudate index on computed tomography. We compared incidence of SDH according to the presence and absence of LD. Results: LD was performed in 53 (46.9%) patients. Of these patients, 14 had SDH measured by Evans index (p=0.089) while seven had SDH measured by bicaudate index (p=0.007). Ventriculoperitoneal shunt was performed in five patients of LD group (p=0.258). Conclusion: LD insertion in patients who underwent coil embolization reduced the risk of SDH after SAH.
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