A giant monocular intra-abdominal CSF pseudocyst mimicking mesenteric cyst in a shunted child with spina bifida and hydrocephalus: A case report of diagnostic challenge and surgical management.

Mathayo Shadrack, Salma Juma Ali, Naomi Siima Rwamuyagaza, Novath Ngowi, Victor Ngotta, Zaitun Bokhary

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Article in International journal of surgery case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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Mathayo ShadrackMuhimbili 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. Electronic address: shadrackmathew@gmail.com.

Salma Juma AliMuhimbili 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.

Naomi Siima RwamuyagazaMuhimbili University of Health and Allied Science (MUHAS), P.O. box 65001, Dar es salaam, Tanzania; Department of Neurosurgery, Muhimbili Orthopedic Institute, P.O. Box 65474, Dar es salaam, Tanzania.

Novath NgowiMuhimbili 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.

Victor NgottaMuhimbili 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.

Zaitun BokharyMuhimbili 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.

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6 · The paper itself

Abstract

backgroundCerebrospinal 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. CASE PRESENTATION: 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. DISCUSSION: 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.

conclusionHigh clinical suspicion, thorough imaging, and timely surgical intervention are key in managing giant CSF pseudocysts in shunted children.

Indexed as

Abdominal cystCSF pseudocystHydrocephalusMesenteric cyst mimicrySpina bifidaVentriculoperitoneal shunt

Identifiers

PMID40674964

DOI10.1016/j.ijscr.2025.111678

PMCPMC12284689

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