Abdominal CSF pseudocyst. Clinical features and surgical management.

Twenty-six cases of abdominal cerebrospinal fluid (CSF) pseudocyst have been reviewed and the clinical features identified. Typical presentation includes abdominal pain and/or distention, with nausea or vomiting. Manifest shunt malfunction is not a prominent feature. Diagnosis can usually be confirmed by abdominal ultrasound and/or CT scan. No clear predisposing factors were identified, although a prior shunt infection was found in 62% of the patients. The number of previous shunt revisions ranged from 0 to 51 (average 11.2). This revision rate is significantly higher than in other groups of patients. CSF obtained at the time of surgery was infected 36% of the time. CSF appearance and laboratory value did not reliably indicate infection as a cause of the pseudocyst. Suggested surgical management consists of a contralateral ventriculoperitoneal shunt or a ventriculoatrial shunt.