Abdominal pseudocyst as a complication of ventriculoperitoneal shunt placement: Review of the literature and a proposed algorithm for treatment using 4 illustrative cases

Abstract

Background:Ventriculoperitoneal (VP) shunt placement is one of the most commonly performed procedures in neurosurgery. One rare complication is the formation of an abdominal pseudocyst, which can cause shunt malfunction.Case Descriptions:We present four unique cases of abdominal pseudocyst formation. Our first patient initially presented with a right upper quadrant pseudocyst. Shunt was externalized and the distal end was revised with placement of catheter on the opposite side. He developed another pseudocyst within 5 months of shunt revision and developed another shunt failure. Our second patient had a history of shunt revisions and a known pseudocyst, presented with small bowel obstruction, and underwent laparotomy for the lysis of adhesions with improvement in his symptoms. After multiple readmissions for the same problem, it was thought that the pseudocyst was causing gastric outlet obstruction and his VP shunt was converted into a ventriculopleural shunt followed by percutaneous drainage of his pseudocyst. Our third patient developed hydrocephalus secondary to cryptococcal meningitis. He developed abdominal pain secondary to an abdominal pseudocyst, which was drained percutaneously with relief of symptoms. The fourth patient had a history of multiple shunt revisions and a previous percutaneous pseudocyst drainage that recurred with cellulitis and abscess secondary to hardware infection.Conclusion:Abdominal pseudocysts are a rare but important complication of VP shunt placement. Treatment depends on etiology, patient presentation, and clinical manifestations. Techniques for revision include distal repositioning of peritoneal catheter, revision of catheter into pleural space or right atrium, or removal of the shunt completely.

Abdominal Cerebrospinal Fluid Pseudocyst as a Complication of Ventriculoperitoneal Shunt Placement

“…Abdominal complications related to VP shunt placement include pseudocysts, intraabdominal infections (e.g. abscess), and bowel perforation [1]. Pseudocysts are more common than ascites, and present as a localized abdominal mass.…”

“…Ventriculoperitoneal (VP) shunt placement is a common neurosurgical procedure performed for the management of hydrocephalus. Although rare, there are potential complications that might arise from the procedure, including abdominal wall perforation, peritonitis, and ascites [1]. Abdominal pseudocyst formation is an uncommon but well-described complication of the procedure.…”

A Rare Case of a CSF Pseudocyst Mimicking a Complex Hepatic Cyst

“…Symptomatic pseudocysts are amenable to percutaneous drainage, repositioning of the distal peritoneal catheter, laparoscopic lysis of adhesions, or may require complete excision of pseudocyst and removal of ventriculoperitoneal shunt hardware. 5 In our case, the patient did have a shunt revision 2 years following this admission with subsequent resolution of the pseudocyst.…”

Cerebrospinal Fluid Pseudocyst Complicating Ventriculoperitoneal Shunt: Report of Four Cases

“…When there is no infection, surgical excision of the cyst wall followed by relocating of the catheter in the peritoneal cavity is the preferred treatment. 21,22 Percutaneous drainage of the cyst with or without surgical evacuation may be tried. 23 Kim et al used excision and repositioning of the shunt tip with minimally invasive laparoscopic techniques.…”