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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Cerebrospinal fluid liver pseudocyst: A bizarre long-term complication of ventriculoperitoneal shunt: A case report
Muhammad Nadeem Yousaf, Haider A Naqvi, Shriya Kane, Fizah S Chaudhary, Jason Hawksworth, Vikram V Nayar, Thomas W Faust
Muhammad Nadeem Yousaf, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO 65212, United States
Haider A Naqvi, Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, United States
Shriya Kane, Department of Surgery, University Iowa School of Medicine, Iowa City, IA 52242, United States
Fizah S Chaudhary, Department of Medicine, University of Missouri, Columbia, MO 65212, United States
Jason Hawksworth, Department of Surgery, Transplant Hepatology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
Vikram V Nayar, Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC 20007, United States
Thomas W Faust, Department of Medicine, Transplant Hepatology, James D. Eason Transplant Institute, Methodist Le Bonheur Healthcare, Memphis, TN 38104, United States
Author contributions: Yousaf MN, Naqvi HA, Kane S, and Chaudhary FS contributed to manuscript writing, proofreads, table and review of data; Faust TW, Hawksworth J, and Nayar VV contributed to overall supervision of manuscript and review of data; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Muhammad Nadeem Yousaf, MD, Academic Fellow, Doctor, Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, 1 Hospital Dr., Columbia, MO 65212, United States. muhammad.n.yousaf@health.missouri.edu
Received: December 19, 2022
Peer-review started: December 19, 2022
First decision: February 21, 2023
Revised: March 2, 2023
Accepted: April 10, 2023
Article in press: April 10, 2023
Published online: May 27, 2023
BACKGROUND
Ventriculoperitoneal (VP) shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid (CSF) into the peritoneum. Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure, mainly because VP shunts have significantly prolonged survival. Of these, liver CSF pseudocysts are rare entities that may cause shunt dysfunction, affect normal organ function, and therefore pose therapeutic challenges.
CASE SUMMARY
A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion, abdominal discomfort/distention. Abdominal computed tomography (CT) scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity. Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy, and repositioning of VP shunt catheter to the right lower quadrant of the abdomen. Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.
CONCLUSION
A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course. Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction. There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity. The reported occurrences have been managed by laparotomy with debridement, paracentesis, radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration. Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst; however, its use is limited by lack of widespread availability and cost of surgery.
Core Tip: Liver cerebrospinal fluid (CSF) pseudocysts are a rare subtype of abdominal cysts that are a late complication of ventriculoperitoneal (VP) shunt. The majority of patients are asymptomatic in early stages, however, as the size of the liver CSF pseudocyst increases this may result in ineffective drainage of CSF, thereby aggravating hydrocephalus symptoms. Liver CSF pseudocyst may be confused with other cystic lesions of liver. Early diagnosis and repositioning VP shunt catheter may prevent both neurological and hepatic complications.
