Formation of Abdominal Cerebrospinal Fluid Pseudocyst

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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“…Otherwise, the abdominal CSF pseudocyst incidence of infection is greater in children than in adults. [24]…”

Section: Discussionmentioning

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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“…However, some series document the feasibility and safety of VPL shunt and of subdural-pleural shunting [ 90 , 97 ]. A few authors have even used VPL shunting as the fi rst option for treating hydrocephalus [ 97 ].…”

Section: Hydrothorax (Pleural Effusion)mentioning

confidence: 99%

“…These facts preclude valid comparisons with other routes for CSF shunting [ 97 ]. Jones et al used an antisiphon device connected with the valve, with the aim of preventing the formation of clinically signifi cant CSF pleural effusions [ 91 ].…”

Section: Hydrothorax (Pleural Effusion)mentioning

confidence: 99%

“…However, we consider that children with VPL shunts must be regularly followed up in view of the reports on tension pleural effusions that can appear at any time, as a result of changes in the valve pressure or in the absorption capability of the pleural cavity [ 91 ]. Megison and Benzel warned about the use of VPL shunting in adults with pulmonary diseases [ 97 ]. The ventilatory reserve must be considered with particular care especially in meningomyelocele patients with kyphoscoliosis and in cases of Chiari malformation [ 97 ].…”

Section: Hydrothorax (Pleural Effusion)mentioning

confidence: 99%

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Complications of CSF Shunting in Hydrocephalus

Rocco

Turğut

Jallo³

et al. 2015

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“…A thin fibrous capsule without epithelial lining forms around the shunt tip and CSF accumulates within, hence the term pseudocysts 2. Low-grade shunt infection, peritoneal adhesions or chronic inflammation are the aetiological factors 3.…”

Section: Descriptionmentioning

confidence: 99%

CSF pseudocyst: an unusual cause of back pain

et al. 2014

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DESCRIPTIONA 27-year-old woman presented with a 10-month history of right-upper back pain that radiated anterolaterally along the right chest wall and was aggravated by coughing and deep inspiration. She had surgical resection of a low-grade cerebellar astrocytoma 21 years previously. Since that time, she had a ventriculoperitoneal (VP) shunt.MRI of the cervicothoracic spinal cord failed to demonstrate any spinal abnormality to account for pain. However, there was a 15×8 cm cystic collection in the right-upper abdominal quadrant ( figure 1A, B; black star). CT of the abdomen was performed for further evaluation. Scout (figure 2A) and axial CT (figure 2B) images revealed the distal tip of the VP shunt coiled in the right subphrenic space) (arrows) and surrounded by a large simple cystic collection compressing the liver. A large amount of clear, serous fluid was drained percutaneously using ultrasound guidance. Laboratory analysis of the fluid was consistent with cerebrospinal fluid (CSF). The shunt was repositioned and her symptoms subsequently resolved. CSFoma is a rare complication of VP shunts particularly in adults.1 A thin fibrous capsule without

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Formation of Abdominal Cerebrospinal Fluid Pseudocyst

Cited by 25 publications

References 20 publications

Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

Complications of CSF Shunting in Hydrocephalus

CSF pseudocyst: an unusual cause of back pain

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