ABDOMINAL CSF PSEUDOCYSTS IN PATIENTS WITH VENTRICULO-PERITONEAL SHUNTS - REPORT OF 14 CASES AND REVIEW OF THE LITERATURE

The abdominal intraperitoneal cerebrospinal fluid pseudocyst is an inf requent but important complication in patients with ventriculoperitone al shunts. Since 1954, 115 cases of paediatric pseudocysts have been r eported in the literature. One additional report deals with an adult p atient. We report on 14 cases of sonographically diagnosed abdominal p seudocysts. Their aetiology, diagnosis, clinical signs and symptoms an d surgical management are investigated. In our hydrocephalus series we have an incidence of pseudocyst formation of 4,5%. The most common pr esentation of the paediatric patients is with symptoms of elevated int racranial pressure and abdominal pain, whereas the adults have predomi nantly local abdominal signs. Diagnosis is readily made with ultrasono graphy. Predisposing factors for pseudocyst formation are multiple shu nt revisions and infection. Microscopically, the pseudocysts consist o f fibrous tissue without epithelial lining. The treatment involves sur gical removal of the catheter with or without excision of the pseudocy st wall and placement of a new catheter intraperitoneally in a differe nt quadrant or an intra-atrial shunt. Recurrences are rare, especially under appropriate medical treatment of infection. In our series, micr obiologically proven infection was present in 30% of the cases.