Mis-diagnosed giant ovarian cyst and ventriculoperitoneal shunt malfunction

Ventriculoperitoneal shunt-associated giant intraperitoneal cerebrospinal fluid pseudocysts: A case report and literature review

Background

Ventriculoperitoneal (VP) shunt placement, a common treatment for hydrocephalus, can lead to various complications, including the formation of cerebrospinal fluid (CSF) pseudocysts within the peritoneal cavity. Although rare, occurring in 1-4.5% of cases, these pseudocysts pose significant clinical challenges due to their potential recurrence and the complexity of their management. The optimal management strategy depends on individual patient factors and the presence of infection.

Case Description

A 24-year-old woman presented with decreased consciousness, worsening headaches, and progressive abdominal enlargement. Imaging revealed a giant intraperitoneal cystic lesion, initially suspected to be a malignant ovarian cyst, but later identified as a CSF pseudocyst associated with the distal tip of a VP shunt placed 9 years earlier. The patient underwent urgent shunt revision, converting to a ventriculoatrial shunt. Postoperatively, her neurological status improved, and the abdominal mass resolved completely within 3 weeks. Follow-up over 1 year confirmed the absence of recurrence or neurological deficits.

Conclusion

VP shunt-associated intraperitoneal CSF pseudocysts, while rare, can develop long after shunt placement and present significant diagnostic and management challenges. Early recognition and appropriate surgical intervention are crucial to prevent complications. This case underscores the importance of individualized treatment approaches and diligent follow-up to ensure favorable outcomes, even in complex cases.