Delayed Abdominal Pseudocyst after Ventriculoperitoneal Shunt Surgery: A Case Report

Abstract

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.

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

“…[11][12][13][14][15] The time between VP shunt surgery and development of abdominal pseudocyst in the above cases ranged from 4 months to 12 years. 11,16 However, in the presented case the patient developed pseudocyst within 6 weeks of VP shunt.…”

“…According to our review of literature, this is the 3rd largest abdominal pseudocyst in a pediatric patient and 7th largest overall in a patient with VP shunt. Only 6 other large pseudocysts have been reported (11)(12)(13)(14)(15)(16), the largest one overall measuring 12.7 l in an adult patient and 30×15.6×11.8 cm being the largest in a pediatric patient. [11][12][13][14][15] The time between VP shunt surgery and development of abdominal pseudocyst in the above cases ranged from 4 months to 12 years.…”

Abdominal pseudocyst complicating ventriculoperitoneal shunt: A rare indication for ventriculopleural shunt conversion

“…Abdominal pseudocyst is a rare complication of VP shunt placement occurring in 0.33%-6.8% of shunt procedures. 18 Its exact etiology is not known, but several predisposing factors have been postulated such as infection, obstruction, dislodgement, and multiple shunt revisions. 12 Surgical removal of the catheter with or without excision of the pseudocyst wall and implantation of a new catheter, 11 or cyst excision and shunt relocation 12,13 are treatment options for this pseudocyst.…”

“…Abdominal pseudocyst is a rare complication of VP shunt placement occurring in 0.33%–6.8% of shunt procedures 18 . Its exact etiology is not known, but several predisposing factors have been postulated such as infection, obstruction, dislodgement, and multiple shunt revisions 12 .…”