From shunt to gut: managing a ventriculoperitoneal shunt–associated abdominal pseudocyst causing bowel obstruction – a case report
Adisa Poljo, Gabriel F. Hess, Severina Leu, Beat P. Müller, Jennifer M. KlasenIntroduction and importance:
Abdominal cerebrospinal fluid pseudocysts (APCs) are a rare complication of ventriculoperitoneal (VP) shunts, occurring in 1–4.5% of cases and potentially causing abdominal symptoms, bowel obstruction, or shunt malfunction. We present a case of a VP shunt–associated pseudocyst leading to mechanical small bowel obstruction.
Presentation of case:
A 40-year-old woman with a long-standing VP shunt presented with abdominal pain, vomiting, and obstipation. CT imaging showed a large pseudocyst encasing the shunt tip and causing mechanical ileus. Emergency surgery revealed adhesion-related small-bowel obstruction, requiring partial cystectomy and ileal resection. cerebrospinal fluid (CSF) cultures grew
Clinical discussion:
APCs may form due to impaired CSF absorption, inflammation, or low-grade infection. In this patient, a chronic shunt infection likely contributed to cyst development and bowel obstruction. Management typically requires cyst drainage or resection, and revision of the distal catheter, with complete shunt removal necessary when infection is present. Early diagnosis and multidisciplinary management are essential to prevent morbidity.
Conclusion:
VP shunt–associated pseudocysts, though rare, can cause acute abdominal emergencies. Prompt imaging, surgical intervention, and appropriate treatment of shunt infection are critical for optimal outcomes.