Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults

Background:Ventriculoperitoneal (VP) shunts are among the most frequently performed operations in the management of hydrocephalus. Hepatic cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with a VP shunt insertion. In addition to presenting our own case, we performed a PubMed search to comprehensively illustrate the predisposing factors, clinical picture, diagnostic methods, and surgical treatment. This article represents an update for this condition.Case Description:A 40-year-old male was admitted to a hospital complaining of fever, abdominal distention, and pain. He had undergone a VP shunt for communicating hydrocephalus caused by a head trauma one year earlier. Laboratory studies showed liver enzymes alterations, and imaging studies demonstrated a well-defined intraaxially hepatic cyst with the shunt catheter placed inside. Staphylococcus epidermis was cultured via CSF. After removing the VP shunt and an adequate antibiotic treatment, the complication of hepatic CSF pseudocyst was resolved.Conclusion:Hepatic CSF pseudocyst is a rare complication of a VP shunt. Once the diagnosis is verified and if the CSF is sterile, just simply remove the peritoneal catheter and reposition a new one in the abdomen. We believe that it is not necessary to remove or aspirate the hepatic intraaxial pseudocyst, because of the risk of bleeding. In case of CSF infection, the VP shunt can be removed and/or an external derivation can be made, and after treatment with antibiotics, a new VP shunt is placed in the opposite side of the peritoneum.

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“…Even more uncommon are pseudocysts of parenchymal organs such as the liver. [2457814151718192527323334] or spleen. [21]…”

Section: Introductionmentioning

confidence: 99%

Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

Dabdoub¹,

Fontoura²,

Santos³

et al. 2013

Surg Neurol Int

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“…[3] Among them, perforation by the peritoneal catheter was reported to have occurred in the vagina, intestine, umbilicus, and the surgical scar of the abdominal wall. [3] Others are transoral[4] or transanal protrusion,[5] extrusion through the scrotum,[6] and formation of abdominal pseudocyst,[7] etc., Spontaneous extrusion of the distal peritoneal catheter through the intact abdominal wall is very rare. [1] The sharp tip at the distal end of the catheter is blamed for higher complication rates.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous extrusion of peritoneal catheter of ventriculoperitoneal shunt through the intact abdominal wall: Report of two cases

et al. 2012

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Among the various complications associated with ventriculoperitoneal shunt (VPS) surgery, migration of the peritoneal catheter is one of the rarest complications. We report two cases of spontaneous extrusion of the peritoneal portion of the VPS through the intact abdominal wall at an area unrelated to the surgical incision. Both were conscious and had no neurological deficits. There were no signs of infection. The peritoneal end of the shunt was removed through the abdomen. Shunt revision was performed. The patients were discharged 8 days after the revision without any complications. At 6-month follow-up, both of them are doing well. Possible mechanisms of abdominal wall perforation are discussed. Pulling the extruded peritoneal end through abdominal wall decreases the possibility of infection and is probably the best way of management.

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“…The most frequent signs and symptoms associated with pseudocysts are abdominal pain, abdominal distention, and a palpable abdominal mass. 37 If there is a high index of suspicion for the accumulation of pseudocysts, ultrasonography is the imaging modality of choice because it is fast and easily attainable. CT of the abdomen will also illustrate similar findings.…”

Section: Abdominal Complicationsmentioning

confidence: 99%

Surgical Treatment for Leptomeningeal Disease

2017

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Background Advancements in cancer treatment have led to more cases of leptomeningeal disease, which requires a multimodal approach. Methods Treatment modalities are reviewed from a neurosurgical standpoint, focusing on intrathecal chemotherapy and shunting devices. Potential complications and how to avoid them are discussed. Results The Ommaya reservoir and the chemoport are used for administering intrathecal chemotherapy. Use of ventriculo-lumbar perfusion can efficiently deliver chemotherapeutic agents and improve intracerebral pressure. Shunting systems, in conjunction with all of their variations, address the challenge of hydrocephalus in leptomeningeal carcinomatosis. Misplaced catheters, malfunction of the system, and shunt-related infections are known complications of treatment. Conclusions From an oncological perspective, the surgical treatment for leptomeningeal disease is limited; however, neurosurgery can be used to aid in the administration of chemotherapy and address the issue of hydrocephalus. Minimizing surgical complications is important in this sensitive patient population.

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Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults

Cited by 43 publications

References 18 publications

Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

Spontaneous extrusion of peritoneal catheter of ventriculoperitoneal shunt through the intact abdominal wall: Report of two cases

Surgical Treatment for Leptomeningeal Disease

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