Ventriculoperitoneal Shunt-Associated Cerebrospinal Fluid Pseudocyst Presenting as Abdominal Distension and Pain in an Adult Female Patient: A Case Report

Ventriculoperitoneal (VP) shunt placement is a common and effective intervention for managing hydrocephalus. While generally successful, this procedure can be associated with rare but serious complications, including cerebrospinal fluid (CSF) pseudocyst formation. These loculated, epithelial-free fluid collections typically form around the distal catheter in the peritoneal cavity and are more commonly seen in pediatric patients. In adults, their presentation may be delayed and often nonspecific, leading to diagnostic challenges. We report the case of a 32-year-old female patient with a history of congenital hydrocephalus and multiple VP shunt revisions, presenting with worsening abdominal pain, distension, and gastrointestinal symptoms. Imaging revealed a large, loculated intraperitoneal fluid collection encapsulating the distal tip of the VP shunt, consistent with a CSF pseudocyst. Ultrasound-guided paracentesis was performed. The patient showed symptomatic improvement following fluid drainage and conservative management. CSF pseudocyst should be considered in the differential diagnosis of abdominal complaints in adults with a history of VP shunt placement, regardless of the time elapsed since the initial surgery. Prompt imaging and multidisciplinary care are essential for diagnosis and management to prevent complications and recurrence.