Abdominal wall pseudocyst complicating a lumboperitoneal shunt

Case contributed by A Prof. Essam G Ghonaim

Presentation

Patient presented with a right lower anterior abdominal wall soft palpable painless mass increasing in size over last three months.

Patient Data

Age: 35 years
Gender: Female

Along the right side of the anterior abdominal wall, there is an irregular yet well defined cystic lesion that has a large extra-abdominal / subcutaneous component and a much smaller intra-abdominal component. The cyst smoothly compresses the corresponding anterior abdominal wall muscles. The average density of the cyst confirms its fluid content (kindly refer to annotated images). The distal end of a shunt tube is seen curled within the cyst and its proximal component is seen accessing the thecal sac in-between DV12 and LV1.

The distal end of a shunt tube is seen curled within the cyst and its proximal component is seen accessing the thecal sac in-between DV12 and LV1 (arrows).

Case Discussion

Shunt placement is by far the most commonly carried out procedure in the management of hydrocephalus 1.

An abdominal pseudocyst is one rare yet important complication of shunt placement that may end up by shunt malfunction 2,3

Complications following lumboperitoneal shunt have been reported in 18% up to 85% of cases 4.

Many procedures are available for managing pseudocysts. Options include percutaneous drainage of the pseudocyst with open or laparoscopic distal repositioning of the peritoneal end, placement of the distal catheter in an alternative location (contralateral abdomen or pleural space), and endoscopic third ventriculostomy with complete removal of shunt hardware 2.

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Case information

rID: 65571
Published: 20th Jan 2019
Last edited: 23rd Jan 2019
Inclusion in quiz mode: Included

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