Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

Abstract

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.

Safe surgical approach to extrahepatic pseudocyst, a rare shunt complication: 2 case reports

“…In literature, it is seen that laparoscopy procedures are favored in the recent years [10]. In the presence of an infection, it is suggested that implanting an external ventricular drain and installing a new shunt after appropriate antibiotherapy and seeing CSF is sterile [2,4,8]. In our cases we saw that, sending the catheter to a different quadrant, without excision of the pseudocysts, is sufficient.…”

“…In pediatric patients, abdominal pseudocysts are mostly presented with the symptoms caused by the elevated intracranial pressure; on the other hand, adult patients are usually presented with abdominal symptoms. There are also cases presented with both symptoms, as ours [2,8]. Main pathologies in differential diagnosis with abdominal pseudocysts are mesenteric or omental cysts, duplication cysts, Iymphocele, cystic teratoma, cystic lymphangioma, pancreatic pseudocyts, abscess and bilomas.…”

“…Main pathologies in differential diagnosis with abdominal pseudocysts are mesenteric or omental cysts, duplication cysts, Iymphocele, cystic teratoma, cystic lymphangioma, pancreatic pseudocyts, abscess and bilomas. It is suggested that abdominal USG and radiography are sufficient for diagnosis, but to determine the exact location, size of the cyst, and the location of the shunt catheter; also to exclude other acute abdominal syndrome reasons, abdominal CT is reported as more valuable [2,4,6,8]. Typically, on extrahepatic pseudocyst cases, CT scan reveals a parenchyma free capsule formation with smooth margin extending out from the liver and isodense cyst content with CSF [6,8,9].…”

“…Intestinal obstruction, intestinal perforation, peritonitis, abscess, bladder perforation and pseudocyst are the main abdominal complications of VP shunts. Pseudocyst occurence rates are reported to be between 1 and 3%, and there are only limited number of cases of VP shunt-induced hepatic pseudocyts in the literature [2,3]. We report two cases of VP shunt induced extrahepatic pseudocyst patients with different backgrounds.…”

Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report

“…Pathogenesis of CSF pseudocyst is at least in part related to the prior abdominal surgery and liver dysfunction [9], as well as infections and allergic reactions to silicone or ethylene oxide [10]. Potential organisms that are implicated in CSF pseudocysts include Staphylococcus epidermidis, Staphylococcus aureus, and Propionibacterium acnes [11]. In the present case, no microorganism growth was observed in the cultures of the cyst fluid and the distal shunt tip.…”