Abdominal Pseudocyst Research Articles

Incidence and Management of Pseudocysts in Patients With Ventriculoperitoneal Shunts: A Study in Pakistan.

Ventriculoperitoneal (VP) shunts are a common medical intervention used to treat hydrocephalus, a condition characterized by the accumulation of cerebrospinal fluid (CSF) in the brain's ventricles, leading to increased intracranial pressure. While VP shunts are effective in managing hydrocephalus, they can lead to complications such as the formation of abdominal pseudocysts, which can compromise the functionality of the shunt and pose significant health risks. The primary objective of this study was to determine the incidence of pseudocyst formation in patients with VP shunts in Pakistan. The secondary objective was to evaluate the outcomes of conservative versus surgical management strategies and identify risk factors associated with pseudocyst recurrence in this population. This prospective observational study was conducted at Jinnah Teaching Hospital, Pakistan, from January 2021 to December 2022. The study included 50 patients diagnosed with pseudocysts associated with VP shunts. Participants were managed with either conservative (observation and aspiration) or surgical interventions (shunt revision, relocation, removal, or pseudocyst excision). The primary outcome measures were the resolution rates of pseudocysts and the incidence of complications. Statistical analysis was performed using chi-square tests, t-tests, and Kaplan-Meier survival analysis, with significance set at p<0.05. The study found a 3.5% incidence of pseudocysts among 1400 VP shunt patients. The median time to pseudocyst formation was 22 months (IQR 18-30). Surgical management yielded an 85% resolution rate compared to 60% for conservative management (p = 0.02). The recurrence of pseudocysts was significantly associated with advanced age (HR 1.8, 95% CI 1.1-3.2), a higher BMI (HR 2.1, 95% CI 1.3-3.7), and the presence of hydrocephalus (HR 1.6, 95% CI 1.2-2.9). Although surgical interventions had a higher complication rate (14% vs. 6% for conservative management), the difference was not statistically significant (p = 0.1). The study highlights a 3.5% incidence of pseudocysts in VP shunt patients, with surgical management proving more effective than conservative methods despite a slightly higher, non-significant risk of complications. These findings underscore the importance of tailored patient management, particularly for those at higher risk of recurrence, and suggest the need for further research to enhance surgical techniques and outcomes, especially in resource-limited settings.

Abdominal Pseudocyst, a Rare Complication of Shunting Procedure: A Case Report

The use of the peritoneal cavity for cerebrospinal fluid (CSF) absorption was introduced in 1905. Since then, the ventriculoperitoneal shunt has been one of the most commonly performed surgeries to treat hydrocephalus. Abdominal pseudocysts are relatively rare abdominal complications due to the insertion of a ventriculoperitoneal shunt. Their incidence varied between 0.33 and 6.8%. We report a young boy with a history of hydrocephalus treated by ventriculoperitoneal shunt he admitted to our department presenting with abdominal pseudocyst revealed by abdominal pain and headache. He underwent surgery, where shunt was externalized and the pseudocyst was excision. The shunt was reinserted after the infection was eradicated in the atrium.

Re-examining the classification of abdominal pseudocysts as surgical site infections through review of broad-range polymerase chain reaction results

BackgroundThe Hydrocephalus Clinical Research Network–quality group (HCRNq) historically defined all abdominal pseudocysts associated with a ventriculoperitoneal shunt as a surgical site infection regardless of culture result. MethodsWe retrospectively reviewed broad-range polymerase chain reaction (BRPCR) results sent between January 2017 and July 2023 from abdominal pseudocyst fluid sent from hospitals around the country to a reference laboratory to help further characterize these collections. ResultsA total of 19 samples were tested via BRPCR between 1/2017 and 7/2023. Two (10.5 %) had organisms identified; one with Staphylococcus epidermidis and one with Candida parapsilosis. No fastidious organisms that would be expected to not grow with typical culture techniques were identified. ConclusionsFew abdominal pseudocysts had organisms identified by BRPCR, suggesting that not all pseudocysts are due to infectious causes. Consideration should be given to alternate causes of pseudocyst development when cultures are negative.

Lower abdominal cyst complicated with suspected infection following INFIX internal fixation for pelvic fracture: a report of two rare cases

BackgroundThe Internal Fixator (INFIX) is a popular method, known for its minimal invasiveness and short operation time, for treating anterior pelvic ring fractures. Studies have shown that postoperative complications may occur, including anterolateral femoral cutaneous nerve injury, the femoral nerve paralysis, and delayed fracture healing. These complications are believed to be related to surgical stimulation, an excessively long lateral end of the connecting rod, a small distance between the screw and bone surface, insufficient pre-bending of the connecting rod, and difficulties in fracture reduction.Case presentationWe report two unique cases of lower abdominal pseudocyst complicated with suspected infection after INFIX treatment of pelvic fractures at our trauma center. Following surgical removal of the internal fixation, resolution of the cysts was observed in both patients, and subsequent postoperative follow-up revealed the absence of any residual sequelae. These cases have not been reported in previous literature reviews.DiscussionThe lower abdominal cysts, potentially arising from the dead space created during intraoperative placement of the INFIX rod, may increase infection risk. The etiology remains uncertain, despite the presence of abnormal inflammation markers in both cases, and staphylococcus aureus found in one. These cysts were confined to the lower abdomen, not involving the internal fixation, and hence, only the INFIX was removed. Postoperative oral cefazolin treatment was successful, with resolved pseudocysts and no subsequent discomfort.ConclusionWe report two unprecedented cases of post-INFIX abdominal cysts, with a suspected link to intraoperative dead space. Despite uncertain etiology, successful management involved INFIX removal and oral cefixime therapy. These findings necessitate further exploration into the causes and management of such complications.

Retraction: Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunts.

[This retracts the article DOI: 10.7759/cureus.18956.].

Endoscopic Ultrasound-guided Trans-esophageal Transmural Drainage of Mediastinal Pseudocysts: A Case Series

Mediastinal pseudocysts (MP) are rare, and surgery is the conventional treatment modality. However, in the last decade, excellent outcomes have been reported with endoscopic transpapillary drainage. Endoscopic ultrasound (EUS) guided trans-esophageal transmural drainage of MP is a minimally invasive and effective non-surgical treatment modality, but the experience is limited. We aimed to report our experience of EUS-guided transmural drainage in 10 patients with MP's. A retrospective analysis of patients with pancreatic fluid collections treated with EUS-guided transmural drainage over the last ten years was completed to to identify patients with MP's. Ten patients (8 males, with a mean age of 34.9±9.17 years) with MP treated with EUS-guided transesophageal transmural drainage were identified. Nine patients with MP had concurrent chronic pancreatitis, and only one had MP following acute necrotizing pancreatitis. The mean size of MP was 5.70±1.64 cm, and nine patients (90%) had concurrent abdominal pseudocyst. EUS-guided transesophageal transmural drainage was technically successful in all ten patients. Transmural plastic stents were placed in 9 patients, whereas one patient underwent single-time complete aspiration of the MP. There were no immediate or delayed procedure-related complications. All ten patients had a successful outcome, with the mean resolution time being 2.80±0.79 weeks. There has been no recurrence of PFC or symptoms in nine (90%) successfully treated patients over a mean follow-up period of 43.3 months. EUS-guided trans-esophageal drainage of MP is safe with a high technical and clinical success rate.

Intra-abdominal cystic lesions after ventriculoperitoneal shunting

Objectives: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with ventriculoperitoneal (VP) shunt. In patients with a VP shunt, abdominal complications have been well described, among which abdominal pseudo cysts are uncommon. In this report, we present our experience in terms of the multi-disciplinary management of intra-abdominal cystic lesions associated with the VP shunt procedure. Methods: From 2016 to 2021, 245 VP shunt procedures were performed in our institution. Intra-abdominal cystic lesions were recorded as intra-abdominal complications (abdominal pseudocyst, intestinal subserosal bowel cyst, and scrotal cyst) in 3 patients. For these patients we retrospectively collected data on medical history, complaints, diagnosis, treatment procedure, and postoperative results. The study was performed on 2 male and 1 female patients. The average patient age was 11.6 months (5 months to 1.5 years). The most common complaint was that of abdominal distention with ileus symptoms. The average time of admission after the catheterization of VP shunt was 1 month; laparotomy was performed for 2 patients in whom treatment was needed for high ligation. Results: A VP shunt operation is followed by abdominal complications in about 5%-47% of all cases. These complications are manifested as ileus symptoms, such as vomiting, abdominal distension, and abdominal pain with intestinal obstruction. Conclusions: In pediatric patients with VP shunts, a shunt catheter-induced abdominal cystic formation should always be considered a complication. Management of these cystic lesions requires the use of a multi-disciplinary approach with neurosurgery and pediatric surgery for treatment.

Abdominal pseudocysts – A cause of peripheral dysfunction in ventriculoperitoneal shunts in children

Abdominal pseudocysts – A cause of peripheral dysfunction in ventriculoperitoneal shunts in children

A very rare case of an intrathoracic pancreatic pseudocyst.

Pancreatic pseudocysts are mostly located in the peripancreatic region, but extra-abdominal intrathoracic extensions can occur and mimic respiratory and ischemic symptoms. Mediastinal location is an example that can present with dyspnea and retrosternal chest pain. Pancreatic-pleural fistulas can form from pseudocysts, often resulting in large and recurrent pleural effusions. In the described case, a 50-year-old man with a previous subdiaphragmatic pseudocyst presented an acute episode of respiratory symptoms and was diagnosed with a newly organized collection located intrathoracically adjacent to the previous one, formed by the fistulization of the abdominal pseudocyst. No similar cases have been described or published in indexed PubMed databases until the year 2023.

A RARE CASE OF ABDOMINAL CEREBROSPINAL FLUID PSEUDOCYST (CSFOMA) : A RARE COMPLICATION OF VENTRICULO-PERITONEAL SHUNT IN PREVIOUSLY TREATED TUBERCULOUS MENINGITIS HYDROCEPHALUS

Ventriculo-peritoneal shunt is a common neurosurgical procedure used in treatment of hydrocephalus in which shunt is created for draining excess of cerebrospinal uid into peritoneal cavity for its absorption through the peritonium. One of its rare but dangerous complication is abdominal pseudocyst which occurs mainly due blockage or obstruction of the shunt and may present as acute abdomen. Here we present a case of post tubercular hydrocephalus treated with ventriculo-peritoneal shunt at the age of 2 years, later developed abdominal cerebrospinal uid pseudocyst (CSFoma) at the age of 14 years. He presented with abdominal distension, ultrasonography showed pseudocyst formation which was conrmed with contrast enhanced computed tomography of abdomen. Ventriculo-peritoneal shunt was later diverted to right pleural cavity forming ventriculo-pleural shunt. Gradually pseudocyst resolved. On further follow up he was found to be doing well with no further complications.

A Descriptive Study on Complications of Ventriculoperitoneal Shunt Surgery in Nangarhar Regional Hospital 25/Mar/2018 – 16/Mar/2019

Ventriculoperitoneal shunt treats hydrocephalus by altering CSF flow within the brain. In most of the cases, shunts consist of three parts, which are serially connected to each other: the proximal catheter, one-way valve and distal catheter. Ventriculoperitoneal shunt is one of the most commonly performed neurosurgical procedure, both on the elective and emergency basis. Consequently, in this paper, the indications for shunt, the types used, cure, and complications of ventriculoperitoneal shunts were studied. During this “Quantitative “, with amalgamating with case series study out of 109 VP-stunted patients, 38 were show up with complication. The shunt complication diagnosis is initially suspected according to the history and physical examination and high intracranial pressure. The purpose of this study is to determine VP-shunt complication, incidence of VP shunt complication in different age of childhood life and geographic findings of complication.&#x0D; 20 patients which is 52.6% of study is male patient, from 2 months to 2 years were 30 patients which (78.3%) of study, 26 complicated patients which is (68.4%) from Nangarhar province. During this study we found 8 patients (21.1%) with abdominal pseudo cyst, 3 patients (7.9%) with skin irritation, 2 patients with (5.3%) fever, 8 patients (21.1%) with shunt upper end and reserve infection, 6 patients (15.8%) with shunt lower end infection, 2 patients (5.3%) with disconnected shunt, 8 patients (21.1%) shunt tube lower end obstruction and 1 patient (2.6) with VP Shunt extrusion from month (real complication).

S3022 Hepatic Cerebrospinal Fluid Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunt

Introduction: Ventriculoperitoneal shunts (VPS) are commonly used in the management of hydrocephalus to drain cerebrospinal fluid (CSF) into the peritoneal cavity. The placement of VPS has prolonged the survival of patients with hydrocephalus. Abdominal pseudocysts are long-term complication of VPS that are identified later in life. Hepatic CSF pseudocyst is a rare long-term complication of VPS that should be differentiated from other cystic lesions of liver. Case Description/Methods: A 49-year-old man with intellectual disability from congenital hydrocephalus s/p placement of right and left-sided VPS at age of 3 months and 7 years respectively presented with exertional dyspnea and abdominal distension. On presentation his vitals were unremarkable except tachycardic (115/min)., He had abdominal distention, hepatomegaly but no tenderness. Initial labs showed D-dimer 2.20 mcg/mL, AST 27 u/L, ALT 38 u/L, alkaline phosphate 126 u/L and total bilirubin 0.5 mg/dL. Chest CT with IV contrast was negative for pulmonary embolism, however revealed a large 18x13x13.5 cm cyst in right hepatic lobe. CT abdomen and pelvis demonstrated a 17.5x12.6x12.7 cm cystic lesion in the right hepatic lobe with the tip of VP shunt catheter within cyst cavity. Hepatobiliary nuclear scan was unremarkable for any biliary leak or sphincter of oddi dysfunction. CT head was negative for any acute abnormalities. Shunt series x-rays were negative for disruption of VPS catheter. Robotic laparoscopic cyst fenestration with partial hepatectomy was performed and catheter was repositioned to the right lower quadrant of abdomen. Patient was discharged home two days later with significant reduction of cyst size on follow up imaging. (Figure) Discussion: This case illustrates a rare complication of VPS that result in hepatic CSF pseudocyst. If hydrocephalus is absent, patients with hepatic CSF pseudocyst are asymptomatic at earlier stages., or they may present with abdominal pain, distention, or palpable right upper quadrant abdominal mass. A subset of patients with hepatic CSF pseudocyst are complicated with bacterial or parasitic infection and present with abdominal pain, distention, or right upper quadrant mass. Abdominal ultrasound and CT scan assist in diagnosis by identifying the tip of VPS catheter in the pseudocyst cavity. Asymptomatic patients are managed conservatively while surgical repositioning of VPS catheter with or without cyst fenestration or surgical excision of cyst may be required for complete resolution of symptoms.Figure 1.: CT of abdomen showing a large right hepatic lobe cyst with evidence of tip of right VPS catheter within the cavity of the cyst (arrows) on transverse (A), axial (B) and lateral (C) views. CT scan of the head (D) showing VPS catheters both in right and left lateral ventricles without evidence of ventricular dilation. Shunt series x-ray (E) shows now distortion of VPS catheter. Robotic laparoscopic cyst fenestration (F) shows VPS catheter within cyst cavity containing CSF.

Subcapsular hepatic pseudocyst as a rare complication of ventriculoperitoneal shunt: A case report

Abdominal pseudocysts are an uncommon complication of ventriculoperitoneal shunt (VPS) placement. Patients may be asymptomatic, or present with symptoms such as abdominal pain, abdominal distension, fever, or vomiting. A 13-year-old girl presented to the emergency department complaining of abdominal pain for one week, with a history of VPS insertion for treatment of hydrocephalus in infancy. Diagnosis of an abdominal pseudocyst was made based on abdominal imaging, demonstrating a hepatic cerebrospinal fluid (CSF) pseudocyst free from infection. The patient was managed with aspiration of the CSF pseudocyst, and no intervention was performed on the VPS as the collection was near the distal catheter of the VPS, there were no signs of high intracranial pressure, and the VPS was in a good position. Hepatic pseudocyst is a rare complication of VPS, and can be challenging to diagnose as the primary symptom, acute abdominal pain, is non-specific. Hepatic pseudocyst should be considered when evaluating patients with VPS presenting with abdominal pain.

Comparison of Shunt Outcomes for Nonbacterial Infection Hydrocephalus with Common Hydrocephalus Etiologies: A Retrospective Case-Control Study

Shunting is an established treatment for hydrocephalus, yet reports on shunt outcomes for nonbacterial infection (NBI) hydrocephalus are limited. Furthermore, comparison of mechanisms and rates of failure for shunted NBI hydrocephalus versus more typical etiologies remains undetermined. Patients who underwent shunting for hydrocephalus at 2 centers (1995-2020) were included. Indications for shunting were grouped as "typical" (congenital, posthemorrhagic, normal pressure hydrocephalus, malignancy-related, trauma, and idiopathic) and NBI hydrocephalus (coccidioidomycosis, cryptococcosis, and neurocysticercosis). Rates of shunt malfunction were compared. There were 261 patients shunted for typical hydrocephalus (48.7% male; age= 50.7±21.7) and 93 patients for NBI hydrocephalus (72.0% male; age= 41.8±13.2). For patients with typical hydrocephalus, 29.5% required ≥1 shunt revision, compared with 64.5% with NBI hydrocephalus (P<1E-5). Of those with malfunction, NBI shunts required more revision operations (median= 3.0; max= 21) than typical shunts (median= 2.0; max= 6; P < 0.05). The censored median time to shunt failure for NBI hydrocephalus was 26.9months and was not reached for typical etiologies by 180months. Multivariate analysis showed shunts for NBI hydrocephalus were significantly more likely to fail (hazard ratio= 2.25; 95% confidence interval= 1.58-3.19). A distal pseudocyst was implicated in 30.0% and 2.6% of shunt failures for NBI and typical hydrocephalus, respectively (P<1E-5). Sixteen (26.7%) NBI shunt failures required revision to lower-resistance systems compared to 6 (7.8%) typical failures (P < 0.05). Shunts placed for hydrocephalus secondary to nonbacterial infections are complicated by significantly higher rates of malfunction. These patients are prone to develop distal abdominal pseudocysts and often require revision to low-resistance systems.

Deflating abdominal pseudocyst causing temporary normalization of ventriculoperitoneal shunt malfunction

Ventriculoperitoneal shunt (VPS)-related abdominal pseudocyst (APC) is a rare cause of shunt malfunction. Variable VPS function due to APC has not been described before. A 21-year-old male with hydrocephalus and bilateral VPS presented with a right-sided shunt malfunction. After a routine abdominal ultrasound (US), that proved to be unremarkable, the patient had a clinical and radiological improvement followed by a relapse. An abdominal computed tomography scan subsequently showed an APC around the peritoneal catheter tip. Laparoscopic intervention on the APC cured the shunt malfunction. We believe that the APC emptied during the compression involved while performing the abdominal US. The pseudocyst collapse led to missing it on the abdominal US and explains the short-lived clinical and radiological improvement. We introduce the concept of APC-related variable VPS function, discuss the possible mechanisms by which the pseudocyst deflated, and make suggestions toward this diagnostic problem.Key Messages: A collapsible abdominal pseudocyst could result in a variable ventriculoperitoneal shunt function. Starting the abdominal ultrasound examination over the location of the peritoneal catheter tip may overcome the collapse. Contrasted computed tomography is superior to ultrasound in diagnosing the pseudocyst.

Pseudocyst of Abdomen Presenting as a Huge Abdominal Mass after Ventriculoperitoneal Shunt: A Case Report

A ventriculoperitoneal shunt is a major surgical modality to relieve intracranial pressure in patients with hydrocephalus. Shunt obstruction and infection are the most common complications following shunt surgery whereas VP shunt-associated pseudocyst formation is a rare complication. These are the cystic space without the epithelial lining, filled with fluid around the distal tip of the catheter.&#x0D; In this case report, we present you a 47-year-old male who underwent VP shunt placed a year back presented with huge abdominal swelling, headache, and weight loss. CT scan of the abdomen showed abdominal pseudocyst with the peritoneal end of the shunt within the cyst.&#x0D; Though the exact mechanism is not known, abdominal adhesion, multiple revisions, obstruction, or dislodgement are thought to predispose to the formation of a pseudocyst.

Risk factors for unchanged ventricles during pediatric shunt malfunction.

Children whose ventricles do not change during shunt malfunction present a diagnostic dilemma. This study was performed to identify risk factors for unchanged ventricular size at shunt malfunction. This retrospective 1:1 age-matched case-control study identified children with shunted hydrocephalus who underwent shunt revision with intraoperative evidence of malfunction at one of the three participating institutions from 1997 to 2019. Cases were defined as patients with a change of < 0.05 in the frontal-occipital horn ratio (FOR) between malfunction and baseline, and controls included patients with FOR changes ≥ 0.05. The presence of infection, abdominal pseudocyst, pseudomeningocele, or wound drainage and lack of baseline cranial imaging at the time of malfunction warranted exclusion. Of 450 included patients, 60% were male, 73% were Caucasian, and 67% had an occipital shunt. The median age was 4.3 (IQR 0.97-9.21) years at malfunction. On univariable analysis, unchanged ventricles at malfunction were associated with a frontal shunt (41% vs 28%, p < 0.001), programmable valve (17% vs 9%, p = 0.011), nonsiphoning shunt (85% vs 66%, p < 0.001), larger baseline FOR (0.44 ± 0.12 vs 0.38 ± 0.11, p < 0.001), no prior shunt infection (87% vs 76%, p = 0.003), and no prior shunt revisions (68% vs 52%, p < 0.001). On multivariable analysis with collinear variables removed, patients with a frontal shunt (OR 1.67, 95% CI 1.08-2.70, p = 0.037), programmable valve (OR 2.63, 95% CI 1.32-5.26, p = 0.007), nonsiphoning shunt at malfunction (OR 2.76, 95% CI 1.63-4.67, p < 0.001), larger baseline FOR (OR 3.13, 95% CI 2.21-4.43, p < 0.001), and no prior shunt infection (OR 2.34, 95% CI 1.27-4.30, p = 0.007) were more likely to have unchanged ventricles at malfunction. In a multicenter cohort of children with shunt malfunction, those with a frontal shunt, programmable valve, nonsiphoning shunt, baseline large ventricles, and no prior shunt infection were more likely than others to have unchanged ventricles at shunt failure.

S1661 Disseminated Intra Abdominal Pancreatic Pseudocysts as a Complication of Severe Pancreatitis: A Rare Case of Hepatic, Splenic, Gastric Wall and Anterior Abdominal Wall Pancreatic Pseudocysts

S1661 Disseminated Intra Abdominal Pancreatic Pseudocysts as a Complication of Severe Pancreatitis: A Rare Case of Hepatic, Splenic, Gastric Wall and Anterior Abdominal Wall Pancreatic Pseudocysts

Ventriculopleural shunts in a pediatric population: a review of 170 consecutive patients.

The authors sought to determine the outcome of using the pleural space as the terminus for ventricular CSF-diverting shunts in a pediatric population. All ventriculopleural (VPl) shunt insertions or revisions done between 1978 and 2018 in patients at Children's Hospital Los Angeles were identified. Data recorded for analysis were age, sex, weight, etiology of hydrocephalus, previous shunt history, reason for VPl shunt insertion or conversion from a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt, valve type, nature of malfunction, presence of shunt infection or pleural effusion, and conversion to a different distal site. A total of 170 patients (mean age 14 ± 4 years) with a VPl shunt who were followed up for a mean of 57 ± 53 months were identified. The reasons for conversion to a VPl shunt for 167 patients were previous shunt infection in 57 (34%), multiple abdominal procedures in 44 (26%), inadequate absorption of CSF in 34 (20%), abdominal pseudocyst in 25 (15%), and obesity in 7 (4%). No VPl revisions were required in 97 (57%) patients. Of the 73 (43%) patients who did require revision, the most common reason was proximal obstruction in 32 (44%). The next most frequent complication was pleural effusion in 22 (30%) and included 3 patients with shunt infection. All 22 patients with a clinically significant pleural effusion required changing the distal end of the shunt from the pleural space. Pleural effusion was more likely to occur in VPl shunts without an antisiphon valve. Of the 29 children < 10 years old, 7 (24%) developed a pleural effusion requiring a revision of the distal catheter to outside the pleural space compared with 15 (11%) who were older (p = 0.049). There were 14 shunt infections with a rate of 4.2% per procedure and 8.2% per patient. VPl shunts in children younger than 10 years of age have a significantly higher rate of symptomatic pleural effusion, requiring revision of the shunt's terminus to a different location. VPl shunt complication rates are similar to those of VP shunts. The technical difficulty of inserting a VPl shunt is comparable to that of a VP shunt. In a patient older than 10 years, all else being equal, the authors recommend that the distal end of a shunt be placed into the pleural space rather than the right atrium if the peritoneal cavity is not suitable.

Unusual Complication of Abdominal Pseudocyst Following Cystoperitoneal Shunt in Posterior Cranial Fossa Arrachnoid Cyst

Abdominal pseudocyst is a rare complication reported of VP shunt surgery. Here, we report a 10-monthsoldboy with abdominal distension following cystoperitoneal (CP) shunt procedure for the fossa posteriorarrachnoid cyst. The diagnosis was based on the clinical symptoms and abdominal USG. Infection andallergic reaction was considered as the underlying cause. The CP shunt was removed to atrioventricularshunt and it resulted in a good response. Abdominal pseudocyst should be considered whenever there isabdominal distension following VP/CP shunt.