A Giant Abdominal Cerebrospinal Fluid Pseudocyst

Abstract

Background and Aim: Ventriculoperitoneal shunt (VPS) is the most commonly used procedure for treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocyst is a rare complication but potentially fatal. The pathogenesis of this complication remains unclear. This complication should be considered during differential diagnosis of an abdominal mass. Our aim is to report how large and giant an abdominal cerebrospinal fluid pseudocyst can develop, and how severe the neurological damage can be. Case Presentation: A 6 year-old girl known to have a ventriculoperitoneal shunt presented with abdominal distension and signs of increased Intracranial Pressure (ICP). Ultrasonography revealed a hypoechoic intraperitoneal fluid containing cyst with a well-defined margin and septations. Abdominal computerized tomography revealed a huge cyst in the abdomen and the distal part of the peritoneal shunt tube located within the cyst. Laparotomy revealed a huge cyst extending from the upper right side of the abdomen to the pelvis. The whole cyst was excised and the catheter repositioned. Conclusion: Early diagnosis of abdominal Cerebrospinal Fluid (CSF) pseudocyst is only possible through close and periodic examination of patients after the procedure.

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.…”

Ultrasound-guided percutaneous aspiration of abdominal pseudocyst following ventriculoperitoneal shunt implantation in a child: A case report

“…[5] e diagnosis can be established with ultrasound and if needed, CT scan demonstrating the pseudocyst and ruling out other pathologies. [8] ere are a variety of options in the management of pseudocyst, including a conservative, minimally invasive, or surgical, which requires a collaboration between pediatric surgeons, neurosurgeons, and interventional radiologists. of the pseudocyst.…”

Cerebrospinal Fluid Pseudocyst Complicating Ventriculoperitoneal Shunt: Report of Four Cases

“…4,6,18 CT scan, which provides precise information, is considered effective in the definitive diagnosis of APC when they are large and deform the normal architecture of the abdomen. 19 It can help recognize other etiologies such as appendicitis, diverticulitis, abdominal abscess, or bowel obstruction. Differential diagnosis of a CSF APC includes lymphangioma, mesenteric cyst, pancreatic pseudocyst, duplication, and cystic teratoma.…”

“…Differential diagnosis of a CSF APC includes lymphangioma, mesenteric cyst, pancreatic pseudocyst, duplication, and cystic teratoma. 19 Plain radiographs are helpful to rule out other causes of acute abdomen and help determine the continuity of the catheter tube.…”