Cerebrospinal Fluid Ascites with a Giant Abdominal Pseudocyst Complicating Ventriculoperitoneal Shunt

Ventriculoperitoneal (VP) shunting is commonly performed for hydrocephalus but may be associated with abdominal complications. There are many known complications associated with cerebrospinal fluid (CSF) shunt surgeries in children, which include shunt infection, obstruction, shunt migration, bowel perforation, peritonitis, and over drainage. One among the rare ones is a sterile abdominal pseudocyst, and the rarest is CSF ascites. An 8-year-old female with a history of lumbosacral myelomeningocele repair and VP shunt placement presented 6.5 years later with progressive abdominal distension, headache, and nausea. Imaging revealed massive ascites with features suggestive of a pseudocyst. CSF analysis showed elevated protein without infection. Initial management with paracentesis and subsequent laparotomy with pseudocyst excision and shunt repositioning failed due to recurrence. Definitive resolution was achieved following exteriorization of the distal shunt and delayed reinsertion after 1 month, avoiding permanent diversion procedures.