International journal of surgery case reports · 2025
A giant monocular intra-abdominal CSF pseudocyst mimicking mesenteric cyst in a shunted child with spina bifida and hydrocephalus: A case report of diagnostic challenge and surgical management.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Shadrack Mathayo, Ali Salma Juma, Rwamuyagaza Naomi Siima, Ngowi Novath, Ngotta Victor, Bokhary Zaitun
Аннотация
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.
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.