Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

Abstract

The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children’s Memorial Hospital in the years 1991–1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.

Hyponatremic seizure due to huge abdominal cerebrospinal fluid pseudocsyt in a child with ventriculoperitoneal shunt: a case report

“…Although the etiology of CSF pseudocyst is not clear, some factors like infections, prior abdominal surgeries, and allergic reactions to silicone or ethylene oxide have been reported to be responsible (9,11,13).…”

Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunts: 30 years of experienceFNx01

“…The reaction of the peritoneum and the intestinal serosa is apparently noninfectious but a poorly understood inflammatory process. [6,8,10] In our patients, this inflammatory process was particularly located around the tip of the peritoneal catheter. The pseudocysts were histologically examined.…”

“…[4,[7][8][9][10] As in other reported cases, the pathological examination showed chronic inflammation and a possible foreign body reaction.…”

“…[4,7] In case of an infection, Staphylococcus epidermidis or Propionibacterium acnes could be detected. [6][7][8]10,12,13] In order to distinguish between an infected and a noninfected pseudocyst, it is important to be aware of the fact that Staphylococcus epidermidis grows slowly and requires prolonged incubation. [4,7,10] Prolonged aerobic and anaerobic cultures should be performed to detect any organism.…”

Safe surgical approach to extrahepatic pseudocyst, a rare shunt complication: 2 case reports

“…Intestinal obstruction, intestinal perforation, peritonitis, abscess, bladder perforation and pseudocyst are the main abdominal complications of VP shunts. Pseudocyst occurence rates are reported to be between 1 and 3%, and there are only limited number of cases of VP shunt-induced hepatic pseudocyts in the literature [2,3]. We report two cases of VP shunt induced extrahepatic pseudocyst patients with different backgrounds.…”