article · International Journal of Surgery Case Reports
Ventriculoperitoneal shunts used to treat hydrocephalus can lead to rare complications known as cerebrospinal fluid pseudocysts, occurring in up to 4.5 percent of paediatric cases. A ten-year-old boy with spina bifida and hydrocephalus presented with gradual, painless abdominal swelling and intermittent low-grade fevers years after shunt placement. Initial contrast-enhanced imaging suggested a mesenteric cyst, and ultrasound-guided drainage yielded haemorrhagic fluid before the fluid collection rapidly recurred. Repeat imaging located the shunt catheter tip directly inside the fluid collection. Surgeons performed an exploratory laparotomy and an en bloc cystectomy to remove the giant pseudocyst. The patient recovered smoothly and was discharged within a week. The findings highlight the importance of considering cerebrospinal fluid pseudocysts in shunted children presenting with abdominal distension to avoid delayed intervention.
Children treated for hydrocephalus rely on shunts to drain fluid away from the brain, but complications in the abdomen can be difficult to identify. Atypical fluid collections can be easily mistaken for other abdominal masses, risking inappropriate delays in care. Recognising this rare complication ensures clinical teams use the right imaging techniques and surgical approaches promptly.
The abstract does not indicate an application pathway, as it is a single clinical case report documenting a diagnostic challenge and standard surgical management.
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BACKGROUND: Cerebrospinal fluid (CSF) pseudocysts are even extremely rare but potentially serious complications of ventriculoperitoneal (VP) shunts, with an incidence reported between 1 % and 4.5 % in pediatric populations. When pseudocysts mimic mesenteric cysts or present atypically, diagnostic confusion and delayed treatment may occur, especially in patients with comorbid conditions like spina bifida and hydrocephalus. CASE PRESENTATION: We report a case of a 10-year-old male born with spina bifida who underwent early back closure and later developed communicating hydrocephalus requiring VP shunting. Following initial shunt placement on the left, malfunction prompted re-shunting on the right. At age 10, he presented with gradual, non-painful right-sided abdominal distension, low-grade intermittent fevers, and preserved bowel habits. Contrast-enhanced CT revealed a large intra-abdominal cystic mass initially suspected as a mesenteric cyst. Ultrasound-guided drainage yielded hemorrhagic fluid; cytology confirmed a benign pseudocyst. Recurrence occurred within weeks. Repeat imaging revealed the VP shunt catheter terminating in the cystic cavity. Exploratory laparotomy confirmed a giant CSF pseudocyst with the catheter tip inside. En bloc cystectomy was performed successfully. The patient recovered well and was discharged within one week. DISCUSSION: CSF pseudocysts, though uncommon, should be considered in any shunted patient presenting with unexplained abdominal swelling. Misdiagnosis may delay definitive care. Literature review emphasizes the rarity of hemorrhagic pseudocysts in pediatric VP shunt recipients and highlights this case's unique association with neural tube defect and recurrent presentations. CONCLUSION: High clinical suspicion, thorough imaging, and timely surgical intervention are key in managing giant CSF pseudocysts in shunted children.
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DOI: 10.1016/j.ijscr.2025.111678
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