Intraperitoneal cerebrospinal fluid pseudocyst with ventriculoperitoneal shunt

Management of sterile abdominal pseudocysts in the context of ventriculoperitoneal shunts: a systematic review

This systematic review investigates the management of sterile abdominal pseudocysts (APCs), a complication associated with ventriculoperitoneal shunts (VPS). Management options for sterile APCs include repositioning and externalization, but there remains no consensus on which management technique is superior in terms of outcomes in recurrence or overall complication rates. Therefore, a comparison of outcomes between shunt externalization and repositioning was conducted. A systematic review was done through PRISMA guidelines, and a search of multiple databases, including Medline and Embase, was conducted from the date of inception until 2023. The search results demonstrated 382 articles. Of the 382 articles, 252 were unique, and 43 articles were included in the analysis after full-text analysis. The results of our analysis indicate there is no significant difference in pseudocyst recurrence and overall complications between externalization and repositioning of the distal shunt catheter. The rate of pseudocyst recurrence for studies with a follow-up of 6 or more months was 25% and 24.1% for repositioning and externalization, respectively (p = 0.99). The overall complication rate for studies with a follow-up of 6 or more months was 44.4% and 34.5% for repositioning and externalization, respectively (p = 0.3861). Although our analysis did not demonstrate a significant difference between the two approaches, further work that includes prospective studies, longer follow-up periods, and larger sample sizes is needed to establish this.

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.