Abdominal Cerebrospinal Fluid Pseudocyst Research Articles

Recurrent giant abdominal cerebrospinal fluid pseudo cyst: A case report and review of literature

Cerebrospinal fluid pseudo cyst is a rare complication of ventriculoperitoneal shunt procedure for hydrocephalus. It is a collection of fluid that accumulate around the tip of the distal catheter and surrounded by a wall of fibrous tissue lacking a true epithelium. There is no exact etiology for this entity. It is associated with high recurrence rate. We are reporting one such case of recurrent cerebrospinal fluid pseudo cyst which was managed by initial exteriorization of abdominal end of shunt followed by excision of the cyst and revision of abdominal end of ventriculoperitoneal shunt.

A case of recurrent abdominal cerebrospinal fluid pseudocyst associated with a ventriculoperitoneal shunt in a child

A case of recurrent abdominal cerebrospinal fluid pseudocyst associated with a ventriculoperitoneal shunt in a child

Hemorrhagic abdominal pseudocyst following ventriculoperitoneal shunt: a case report

BackgroundAbdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far.Case presentationThis article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. She denied any additional symptoms. A VP shunt was performed 15 years earlier to treat idiopathic normal pressure hydrocephalus and no other abdominal surgery was performed. Physical examination revealed an elastic palpable mass in her right lower abdomen, which was dull to percussion. Abdominal computed tomography (CT) scan indicated a large cystic collection of homogenous iso-density fluid in the right lower abdominal region with clear margins. The distal segment of the peritoneal shunt catheter was located within the cystic mass. Abdominal CSF pseudocyst was highly suspected as a diagnosis. Laparoscopic cyst drainage with removal of the whole cystic mass was performed, 15-cm cyst which found with thick walls and organized chronic hematic content. No responsible vessel for the cyst hemorrhage was identified. No further shunt revision was placed. Histological examination showed that the cyst wall consisted of outer fibrous tissue and inner granulation tissue without epithelial lining, and the cystic content was chronic hematoma. The patient had an uneventful postoperative course and remained asymptomatic for 8-mo follow-up.ConclusionTo the best of our knowledge, this is the first report of hemorrhagic onset in the abdominal pseudocyst following VP shunt. Such special condition can accelerate the appearance of clinical signs of the abdominal pseudocyst after VP shunts, and its mechanisms may be similar to the evolution of subdural effusion into chronic subdural hematoma (CSDH).

Gigantic Abdominal Pseudocyst: An Unusual Evolution of the Ventriculoperitoneal Shunt

Background: The ventriculoperitoneal (VPS) shunt is the most common procedure in the treatment of hydrocephalus in children. Abdominal cerebrospinal fluid pseudocysts are a rare complication of the ventriculoperitoneal shunt with an incidence ranging from less than 1% to 10% and are more prevalent in children. The malfunction of the ventriculoperitoneal shunt can cause headaches, nausea, vomiting, altered level of consciousness and abdominal pain due to the accumulation of cerebrospinal fluid. There is no consensus on which type of treatment is better in this case, but there are several available methods. Aim: To report an unusual case of a giant abdominal cerebrospinal fluid pseudocyst as a complication of the VPS. Case Presentation: Female 1 y/3 months old patient, less than 7 kg, that has been diagnosed with hydrocephalus prenatally, confirmed postnatally associated with an esophageal atresia and distal tracheoesophageal fistula (AE/FTE, Gross III), was admitted to our service with progressive abdominal distention without obstructive intestinal signs or peritoneal inflammatory signs. The CT scan of the abdomen showed a large liquid collection (estimated volume of 600 ml), centered on the umbilical region, diagnosed as a giant abdominal cerebrospinal fluid (CSF) pseudocyst from the VPS. All of data and information were obtained from her medical records at the infirmary of the Conjunto Hospitalar de Sorocaba (CHS), São Paulo. Conclusion: Abdominal CSF as a cause of these giant pseudocysts should be considered as a diagnostic hypothesis for cases of large abdominal distensions without intestinal involvement in patients with a VPS. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Large abdominal cerebro-spinal fluid pseudocyst mimicking mesenteric cyst in an adult: A rare presentation

Abdominal cerebrospinal fluid pseudocyst occurring after ventriculoperitoneal shunt procedure for hydrocephalous is a rare complication. It is sometimes seen in children and is very rare in adults. We are here in reporting a case of 23 years unmarried female who underwent ventricul operitoneal shunt procedure for hydrocephalus at the age of 6 months and remained asymptomatic thereafter. After 22 years of this procedure, she presented with abdominal pain, distention, vomiting and a progressively increasing large cystic lump in upper and mid-abdomen that was initially diagnosed as mesenteric cyst. However, on CECT abdomen, it came out to be a large abdominal cerebro spinal fluid (CSF) pseudo cyst. It was an unusual delayed complication of ventriculoperitoneal shunt procedure that was successfully managed with surgical intervention. This case emphasizes that this unusual presentation should be known to the surgeons who mostly deal with abdominal masses.

Unusual cause of abdominal distension: Infected abdominal cerebrospinal fluid pseudocyst

Unusual cause of abdominal distension: Infected abdominal cerebrospinal fluid pseudocyst

Abdominal pseudocyst secondary to ventriculoperitoneal shunt along with left staghorn renal calculus management: A rare case report

Abdominal cerebrospinal fluid pseudocyst is an unusual and important complication in patients with ventriculoperitoneal (VP) shunt. Abdominal pseudocyst secondary to long-term (23 years) VP shunt is a rare complication, and associated staghorn calculus presentation is not yet reported in the literature. Herein, we present our management of abdominal pseudocyst with left staghorn calculus removal at the same sitting.

A Case of Abdominal Cerebrospinal Fluid Pseudocysts Associated with a Ventriculoperitoneal Shunt

A Case of Abdominal Cerebrospinal Fluid Pseudocysts Associated with a Ventriculoperitoneal Shunt

Post ventriculoperitoneal shunt abdominal pseudocyst: Challenges posed in management.

Background:In patients with hydrocephalus, the abdominal cavity has been used for absorption of cerebrospinal fluid (CSF) since 1905. Ventriculoperitoneal (VP) shunt operation is followed by abdominal complications in about 5-47% cases. Abdominal CSF pseudo cyst is an uncommon, but well described complication.Aim:This survey was conducted to study the clinical profile and management of this entity. We present our experience with cases of CSF pseudo cyst in children.Materials and Methods:Retrospective analysis of 4 cases diagnosed to have abdominal pseudo cyst following VP shunt between 2008 and 2013. All the four cases were suspected clinically and diagnosis was confirmed by abdominal ultrasonography.Results:In three patients, the cyst was multilocular and of varying size. Fourth one had a unilocular cyst at the lower end of VP shunt. All the four patients had features of varying degree raised intracranial pressure and a two patients had abdominal signs also. All the patients needed open exploration. Cyst fluid was drained and partial to complete excision of the cyst was done along with the repositioning of the shunt in abdominal cavity in three patients and exteriorization of shunt in one patient. Patients were followed for any further complication over a period of 1-year.Conclusion:Abdominal pseudo cyst is a rare complication after VP Shunt and could result in shunt malfunction or abdominal symptoms and signs. Whenever suspected it should be confirmed by imaging, followed by open exploration and repositioning of the shunt.

Abdominal pseudocyst: a rare complication of ventriculoperitoneal shunting

Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare complication of ventriculoperitoneal shunting. It is well known in children but uncommon in adults. We present a 30-year-old woman with abdominal distension,...

Abdominal Cerebrospinal Fluid Pseudocyst Masquerading as Ascites in an Adolescent Girl

Abdominal Cerebrospinal Fluid Pseudocyst Masquerading as Ascites in an Adolescent Girl

A 27-Year-Old Man with a Rare Cause of Smouldering Abdominal Pain: Propionibacterium Acnes Positive Abdominal Cerebrospinal Fluid Pseudocyst

A 27-year-old man with Crouzon syndrome with multiple craniofacial surgeries and ventriculoperitoneal (VP) shunt placement for hydrocephalus presented with abdominal pain. He experienced a few weeks of gradual worsening abdominal discomfort. Three days prior to presentation, his pain became severe and localized to the right upper quadrant. In the ED, he was hemodynamically stable but had leukocytosis. Abdominal ultrasound revealed a 14-cm hypoechoic, septated fluid collection in the right abdomen. Abdominal CT revealed a thin-walled cystic mass surrounding the VP shunt tip suggestive of a cerebrospinal fluid (CSF) pseudocyst. CT head did not reveal acute pathology. Surgical services were consulted and performed shunt externalization: construction of a distal catheter to drain CSF from the pseudocyst into a proximal catheter connected to a percutaneous bag. Intraoperatively, approximately 250 mL of CSF was drained. The original catheter tip was cut off and tested positive for Propionibacterium acnes. He received a 14-day course of IV ceftriaxone. Later, he underwent successful shunt reinsertion into the left abdominal parietal-pleural space without pseudocyst recurrence. DISCUSSION VP shunt is a rare cause of abdominal pseudocyst with a reported incidence of 1-4.5%, usually developing between 3 weeks to 5 years after shunt placement/revision [1]. Children commonly present with symptoms related to increased intracranial pressure and abdominal pain while adults predominantly present with abdominal complaints [1]. Although the exact etiology of VP shunt-associated pseudocyst is incompletely understood, histologic evidence of inflammation is nearly always present, possibly to the catheter or CSF [2]. Infection may occur, often with Staphylococcus epidermidis, Staphylococcus aureus, or Propionibacterium acnes [2]. Management of abdominal CSF pseudocysts is either immediate shunt activation or shunt externalization and antibiotic therapy [2]. Pseudocysts often require laparoscopic-assisted fluid drainage with pseudocyst wall excision. If clinical and radiographic monitoring reveals recurrence of abdominal pseudocyst, CSF may need to be diverted into other cavities.Figure 1Figure 2Figure 3

Abdominal cerebrospinal fluid pseudocyst following ventriculo-peritoneal shunt surgery: A case report and review of literature.

27Jul 2016 Abdominal cerebrospinal fluid pseudocyst following ventriculo-peritoneal shunt surgery: A case report and review of literature. Indrajit Rana and Chandragupta Chongtham DNB General Surgery Resident, Shija Hospitals & Research Institute, Imphal, Manipur, India. Consultant General & Minimal Access Surgeon, Shija Hospitals & Research Institute, Imphal, Manipur, India.

Abdominal Cerebrospinal Fluid Pseudocyst Diagnosed by Point-of-Care Ultrasound

Abdominal cerebrospinal fluid pseudocyst is an uncommon complication of ventriculoperitoneal shunt and is seen more commonly in the pediatric population. The diagnosis of an abdominal cerebrospinal fluid pseudocyst is typically made by ultrasonography, which demonstrates a simple or loculated fluid collection in the abdomen. We present a case of abdominal pseudocyst diagnosed by point-of-care ultrasound.

A Novel Rapidly Growing Mycobacterium Species Causing an Abdominal Cerebrospinal Fluid Pseudocyst Infection.

Nontuberculous mycobacteria (NTM) are a rare cause of ventriculoperitoneal shunt infections. We describe the isolation and identification of a novel, rapidly growing, nonpigmented NTM from an abdominal cerebrospinal fluid pseudocyst. The patient presented with fevers, nausea, and abdominal pain and clinically improved after shunt removal. NTM identification was performed by amplicon and whole-genome sequencing.

Abdominal Cerebrospinal Fluid Pseudocysts in Children: A Complication of Ventriculoperitoneal Shunt

Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare complication of ventriculoperitoneal (VP) shunt. It is characterized by collection of cerebrospinal fluid in the peritoneal cavity, containing the distal end of the VP shunt catheter and is surrounded by a wall composed of fibrous tissue without an epithelial lining. In this article, we report four cases of abdominal cerebrospinal fluid pseudocyst in children with VP shunt, performed for tuberculous meningitis with hydrocephalus. We have described the etiopathogenesis, the symptomatology, the diagnostic investigations, the treatment method adopted, and proposed a simple and effective treatment protocol that has resulted in rapid resolution of symptoms in all our patients. Also, one of our cases had the largest abdominal CSF pseudocyst reported in the literature with respect to weight and height of the child.

Récurrence d’un kyste abdominal de liquide céphalo-rachidien chez un adolescent de 14 ans porteur d’un drain ventriculo-péritonéal

Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare complication of ventricular-peritoneal shunt (VPS) but needs to be considered in every patient with abdominal complaints or signs of intracranial hypertension (IH). The pathogenesis of pseudocysts remains unclear. Diverse predisposing factors have been proposed such as previous abdominal surgeries, multiple VPS revisions, infections, history of necrotizing enterocolitis, and nonspecific inflammatory processes. We report the case of a 14-year-old patient, known to have a VPS as intraventricular hemorrhage treatment, presenting cephalalgia, vomiting, apathy, and an indurate abdominal mass without fever. The first abdominal CSF pseudocyst diagnosis had been established 3 months earlier. Abdominal ultrasounds confirmed a large homogeneous cyst with the shunt tip within the pseudocyst. Cerebral CT revealed an increased ventricular size. An exploratory laparotomy with cyst aspiration, lysis of adhesions, excision of cystic walls, and repositioning of the peritoneal catheter was performed. No antibiotics were initiated given that the cultures were negative. Ultrasonography proved to be the method of choice in the diagnosis of VPS abdominal complications, especially CSF pseudocyst. CT can also reliably confirm the pseudocyst. In case of IH signs, a cerebral CT scan can be performed to evaluate the ventricular distension and to check the shunt position. Various methods to process the cyst have been described in the medical literature, but the recurrence rate remains elevated (25-100%). Then the probability of an infection without any clinical sign has to be considered. In case of suspected infection, the VPS is removed and replaced by an external ventricular drain. Antibiotics are started and adjusted to the results of the CSF culture. If there is no direct sign of infection, only the distal catheter is externalized and antibiotics are introduced until infection is treated. Depending on the peritoneal absorption state, the distal catheter is replaced in the abdominal cavity or in the atrium, the pleural space or the gallbladder if there is no suitable place for repositioning. If the peritoneal state allows it, a laparoscopic procedure is recommended to avoid peritoneal adhesion formation increasing the recurrence rate of CSF pseudocyst.

Abdominal cerebrospinal fluid pseudocyst: a comparative analysis between children and adults

Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare but important complication in patients with ventriculoperitoneal shunt (VPS). In addition to presenting our experience, we performed a comparative analysis between children and adults with this entity. To the author's knowledge, there are no studies in which this condition has been compared. The PubMed database was searched for all relevant reports published from 1954 to 2012. The differences were statistically compared, especially regarding clinical investigations, etiology of the hydrocephalus, shunt revision, CSF infection, treatment, and recurrence. Chi-square test or Fisher's exact test was used to find associations among the variables. Compiled from literature, we found 393 cases of abdominal pseudocyst: 295 children, including our cases, and 55 adults, with age not informed in 43 cases. In children, 33 % of the patients have a positive culture on presentation, with higher incidence in children younger than 10 years. In contrast, only 15 % among adults were positive CSF culture. In total, 287 abdominal pseudocyst cases who underwent shunt revision have been reported; 78.4 % of children and 62.2 % of adults. The main occurrence of this complication according to the etiology of hydrocephalus in children was different from adults. The recurrence of pseudocyst occurred in 19.8 and 24.2 % of children and adults, respectively. The differences between children and adults might represent distinct trends on the etiology and treatment of this entity. Hence, additional well-designed cohort studies will be necessary to strengthen our findings.

CSF pseudocyst: an unusual cause of abdominal distension in a child

Abdominal cerebrospinal fluid pseudocyst is an uncommon complication of ventriculoperitoneal (VP) shunt placement. We present the case of a 4 year old child in whom a VP shunt was placed for tubercular meningitis 5 months earlier. The clinical presentation, classic imaging findings and management of CSF pseudocyst in a child are discussed.

Largest Abdominal CSF Pseudocyst – An Uncommon Complication of VP Shunt

Abdominal cerebrospinal fluid (CSF) pseudocyst is an unusual and important complication in patients with ventriculoperitoneal (VP) shunt. A 36yrs old male referred to the Department of Radiology for USG abdomen with complaints of gradually increasing distension of abdomen and provisional diagnosis of Alcoholic liver disease. Successive radiological investigations lead to diagnosis of malfunctioning VP shunt, secondary to abdominal CSF pseudocyst formation. Due to lack of suspiciousness patient had developed a giant abdominal CSF pseudocyst, size of which has not been reported in any literature so far. Hence, initial suspicion with appropriate investigation and early treatment can prevent morbidity and mortality. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 89-90 DOI: http://dx.doi.org/10.3126/njr.v3i1.8820