Shadrack Mathayo, Ali Salma Juma, Rwamuyagaza Naomi Siima, Ngowi Novath, Ngotta Victor, Bokhary Zaitun
Muhimbili University of Health and Allied Science (MUHAS), P.O. box 65001, Dar es salaam, Tanzania; Department of pediatric Surgery, Muhimbili National Hospital (MNH), P.O. Box 65000, Dar es salaam, Tanzania; Department of Pediatric Surgery, Kilimanjaro Christian Medical Center, P.O. Box 3010, Moshi, Kilimanjaro, Tanzania; Kilimanjaro Christian Medical University, P.O. Box 2240, Moshi, Kilimanjaro, Tanzania.
Muhimbili University of Health and Allied Science (MUHAS), P.O. box 65001, Dar es salaam, Tanzania; Department of pediatric Surgery, Muhimbili National Hospital (MNH), P.O. Box 65000, Dar es salaam, Tanzania.
Int J Surg Case Rep. 2025 Aug;133:111678. doi: 10.1016/j.ijscr.2025.111678. Epub 2025 Jul 14.
Cerebrospinal fluid (CSF) pseudocysts are even extremely rare but potentially serious complications of ventriculoperitoneal (VP) shunts, with an incidence reported between 1 % and 4.5 % in pediatric populations. When pseudocysts mimic mesenteric cysts or present atypically, diagnostic confusion and delayed treatment may occur, especially in patients with comorbid conditions like spina bifida and hydrocephalus.
We report a case of a 10-year-old male born with spina bifida who underwent early back closure and later developed communicating hydrocephalus requiring VP shunting. Following initial shunt placement on the left, malfunction prompted re-shunting on the right. At age 10, he presented with gradual, non-painful right-sided abdominal distension, low-grade intermittent fevers, and preserved bowel habits. Contrast-enhanced CT revealed a large intra-abdominal cystic mass initially suspected as a mesenteric cyst. Ultrasound-guided drainage yielded hemorrhagic fluid; cytology confirmed a benign pseudocyst. Recurrence occurred within weeks. Repeat imaging revealed the VP shunt catheter terminating in the cystic cavity. Exploratory laparotomy confirmed a giant CSF pseudocyst with the catheter tip inside. En bloc cystectomy was performed successfully. The patient recovered well and was discharged within one week.
CSF pseudocysts, though uncommon, should be considered in any shunted patient presenting with unexplained abdominal swelling. Misdiagnosis may delay definitive care. Literature review emphasizes the rarity of hemorrhagic pseudocysts in pediatric VP shunt recipients and highlights this case's unique association with neural tube defect and recurrent presentations.
High clinical suspicion, thorough imaging, and timely surgical intervention are key in managing giant CSF pseudocysts in shunted children.
脑脊液（CSF）假性囊肿是脑室腹腔（VP）分流术极为罕见但潜在严重的并发症，据报道在儿科人群中的发生率为1%至4.5%。当假性囊肿类似肠系膜囊肿或表现不典型时，可能会出现诊断混淆和治疗延迟，尤其是在患有脊柱裂和脑积水等合并症的患者中。
我们报告一例10岁男性患儿，出生时患有脊柱裂，早期进行了背部闭合手术，后来发展为交通性脑积水，需要进行VP分流术。最初在左侧放置分流管后出现故障，促使在右侧重新进行分流。10岁时，他出现了右侧腹部逐渐增大、无痛性腹胀、低热和间歇性发热，排便习惯正常。增强CT显示腹腔内有一个大的囊性肿块，最初怀疑是肠系膜囊肿。超声引导下引流得到血性液体；细胞学检查证实为良性假性囊肿。数周内复发。重复影像学检查显示VP分流管末端位于囊腔内。剖腹探查证实为巨大的脑脊液假性囊肿，导管尖端在囊肿内。成功进行了整块囊肿切除术。患者恢复良好，一周内出院。
脑脊液假性囊肿虽然不常见，但对于任何出现不明原因腹部肿胀的分流患者都应考虑。误诊可能会延迟确定性治疗。文献综述强调了儿科VP分流术受者中出血性假性囊肿的罕见性，并突出了该病例与神经管缺陷和复发性表现的独特关联。
高度的临床怀疑、全面的影像学检查和及时的手术干预是管理分流儿童巨大脑脊液假性囊肿的关键。
