Malignant Cause of Ventriculoperitoneal Shunt ‘Pseudocyst': A Case Report

Abstract

Abdominal pseudocysts are an uncommon complication of ventriculoperitoneal (VP) shunts. We present the case of a 4-year-old boy with a history of complicated hydrocephalus managed with a VP shunt due to sequelae of prematurity. The patient presented with abdominal distention, and a pseudocyst was diagnosed. Despite shunt externalization and aspiration, the pseudocyst continued to produce up to 1 liter of serosanguineous fluid per day. After MRI revealed malignant features within the pseudocyst, laparotomy was performed and the pseudocyst was partially excised. Pathology reports suggested sarcoma. The cystic mass grew back aggressively, accompanied by distant metastasis. The patient's condition deteriorated and he died from his disease. To our knowledge, this represents the first report of an abdominal malignancy mimicking a pseudocyst and causing VP shunt failure.

Delayed Abdominal Pseudocyst after Ventriculoperitoneal Shunt Surgery: A Case Report

“…Our adult case exhibited onset 26 years after VPS surgery. This case is considered to be an extremely a rare case of abdominal pseudocyst, because abdominal pseudocyst typically occurs 3 weeks to 5 years after VPS surgery in younger patients 1) . Thus, it is important to consider an abdominal pseudocyst in adults as a candidate cause of acute malfunction of a VPS system, even when more than 5 years have passed since the operation.…”

“…Likewise, there is no evidence of any infection in this case report. In the case of children, patients with brain tumors who have VPS placed are more likely to develop pseudocysts, perhaps because of the elevated protein in the CSF interfering with abdominal absorption 1,2) . According to Pinto and de Oliveira 7) , VPS catheter is a foreign body that can cause infection or other foreign body reactions, resulting in epithelial responses which may lead to inflammation and obstruction.…”