Intraabdominal Fluid Collections

It is rare for ascites to develop as a result of the peritoneal cavity failing to cope with the CSF load, except where there is additional abdominal pathology such as adhesions from previous sepsis, surgery or ongoing infection. Hydroceles and an increased incidence of inguinal hernia are recognized complications of ventriculoperi-toneal shunts in infants.

More common is the formation of localized CSF collections within the peritoneal cavity. Abdominal pain and distension are common symptoms in the presence of such CSF pseudo-cysts; these can be readily diagnosed on ultrasound examination. The presence of a CSF pseudocyst should always raise the possibility of underlying infection, which has been reported to occur in two-thirds or more of cases [16].

In such cases, management should be aimed at eradication of the infection, with either removal or externalization of the infected shunt. Although some neurosurgeons have recommended conversion to a VA shunt, a history of pseudocyst formation does not necessarily preclude the continued use of the peritoneal cavity as the distal site.

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