Largest Abdominal CSF Pseudocyst – An Uncommon Complication of VP Shunt

Abstract

Abdominal cerebrospinal fluid (CSF) pseudocyst is an unusual and important complication in patients with ventriculoperitoneal (VP) shunt. A 36yrs old male referred to the Department of Radiology for USG abdomen with complaints of gradually increasing distension of abdomen and provisional diagnosis of Alcoholic liver disease. Successive radiological investigations lead to diagnosis of malfunctioning VP shunt, secondary to abdominal CSF pseudocyst formation. Due to lack of suspiciousness patient had developed a giant abdominal CSF pseudocyst, size of which has not been reported in any literature so far. Hence, initial suspicion with appropriate investigation and early treatment can prevent morbidity and mortality.

Management strategies for giant abdominal pseudocyst in a patient with ventriculoperitoneal 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.…”

“…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. 11,16 However, in the presented case the patient developed pseudocyst within 6 weeks of VP shunt.…”