Advertisement

Child's Nervous System

, Volume 26, Issue 9, pp 1243–1245 | Cite as

Abdominal cerebrospinal fluid (CSF) pseudocyst presented with inferior vena caval obstruction and hydronephrosis

  • Gilberto Ka Kit Leung
Case Report

Abstract

Purpose

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication of ventriculo-peritoneal shunt placement. A large pseudocyst may exert a significant pressure effect, but vascular or urological symptoms are extremely rare. We report an unusual case of a CSF pseudocyt causing inferior vena caval and ureteric obstruction.

Case

A 14-year-old girl had previously undergone ventriculo-peritoneal shunting for congenital hydrocephalus. She developed bilateral ankle edema as the only presenting symptom of a large non-infected cerebrospinal CSF pseudocyst. The associated abdominal distension was initially attributed to obesity, and the patient was unable to communicate due to developmental delay. Imaging studies showed that the pseudocyst was causing inferior vena caval obstruction and bilateral hydronephrosis. The ankle edema and hydronephrosis resolved after aspiration of the pseudocyst and shunt revision.

Conclusion

Children who require CSF shunting may suffer from associated developmental delay and are frequently unable to communicate their symptomatic complaints. This case illustrated the importance of a heightened clinical suspicion in managing these patients in whom shunt failure may present with subtle and obscure signs of lower body venous congestion.

Keywords

Ventriculo-peritoneal shunt Cerebrospinal fluid Pseudocyst Hydronephrosis Complication Inferior vena cava 

Notes

Acknowledgement

None

Declaration of interest

None

References

  1. 1.
    Arnell K, Cesarini K, Lagerqvist-Widh A, Wester T, Sjolin J (2008) Cerebrospinal fluid shunt infections in children over a 13-year period: anaerobic cultures and comparison of clinical signs of infection with Propionibacterium acnes and with other bacteria. J Neurosurg Pediatr 1:366–372CrossRefPubMedGoogle Scholar
  2. 2.
    Chung JJ, Yu JS, Kim JH, Nam SJ, Kim MJ (2009) Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. AJR Am J Roentgenol 193:1311–1317CrossRefPubMedGoogle Scholar
  3. 3.
    Clarke CE, Paul KS, Lye RH (1983) Ventriculoperitoneal shunt procedure complicated by ureter obstruction. Case report. J Neurosurg 59:542–544CrossRefPubMedGoogle Scholar
  4. 4.
    Gaskill SJ, Marlin AE (1989) Pseudocysts of the abdomen associated with ventriculoperitoneal shunts: a report of twelve cases and a review of the literature. Pediatr Neurosci 15:23–26, discussion 26–27CrossRefPubMedGoogle Scholar
  5. 5.
    Kelly JH, McCullough DL, Harrison LH (1989) Lumbar ureteral shunt—an unusual cause of ureteral obstruction. Urology 33:309–310CrossRefPubMedGoogle Scholar
  6. 6.
    Oh A, Wildbrett P, Golub R, Yu LM, Goodrich J, Lee T (2001) Laparoscopic repositioning of a ventriculo-peritoneal catheter tip for a sterile abdominal cerebrospinal fluid (CSF) pseudocyst. Surg Endosc 15:518CrossRefPubMedGoogle Scholar
  7. 7.
    Pathi R, Sage M, Slavotinek J, Hanieh A (2004) Abdominal cerebrospinal fluid pseudocyst. Australas Radiol 48:61–63CrossRefPubMedGoogle Scholar
  8. 8.
    Piercy SL, Gregory JG, Young PH (1984) Ventriculo-peritoneal shunt pseudocyst causing ureteropelvic junction obstruction in a child with myelomeningocele and retrocaval ureter. J Urol 132:345–348PubMedGoogle Scholar
  9. 9.
    Rainov N, Schobess A, Heidecke V, Burkert W (1994) Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature. Acta Neurochir Wien 127:73–78CrossRefPubMedGoogle Scholar
  10. 10.
    Roitberg BZ, Tomita T, McLone DG (1998) Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunt in children. Pediatr Neurosurg 29:267–273CrossRefPubMedGoogle Scholar
  11. 11.
    Sullivan MJ, Banowsky LH, Lackner LH (1972) A urological complication of lumbar subarachnoid shunt. Ureteral obstruction by extrinsic compression. Am J Dis Child 123:597–598PubMedGoogle Scholar
  12. 12.
    Viets DH, Stier FM, Bergman SM (1979) Urinary tract obstruction secondary to cerebrospinal fluid cysts. Urology 13:541–543CrossRefPubMedGoogle Scholar
  13. 13.
    Yount RA, Glazier MC, Mealey J Jr, Kalsbeck JE (1984) Cerebrospinal fluid ascites complicating ventriculoperitoneal shunting. Report of four cases. J Neurosurg 61:180–183CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Division of Neurosurgery, Department of Surgery, The University of Hong KongQueen Mary HospitalHong KongChina

Personalised recommendations