Background: Abdominal cerebrospinal fluid (CSF) pseudocyst is a rare complication of ventriculoperitoneal (VP) shunt, with an incidence from 0.25% to 10%, and a recurrence rate up to 19.8%. We reported the first documented case from Sudan of a fatal VP shunt-associated intraperitoneal pseudocyst in an infant, highlighting diagnostic and management challenges in resource-limited settings and providing a literature review to explore the management and outcomes. Case Description: An 8-month-old female who underwent two shunt revisions for primary hydrocephalus with a VP shunt presented with acute abdominal distension and fever, which lasted 4 days. Physical examination revealed a palpable, tense mass, dull on percussion, with a positive transillumination test, and a slow-refilling shunt. Abdominal X-ray and ultrasound showed an 11 × 10 cm encapsulated fluid collection surrounding the shunt tip. A computed tomography scan was not performed as it was unavailable. Laboratory findings included leukocytosis and elevated C-reactive protein, but sterile CSF cultures. Laparotomy confirmed the intraperitoneal pseudocyst with extensive bowel adhesions, so we performed both partial excision of the pseudocyst wall and shunt repositioning. Postoperatively, the patient developed hypokalemia with convulsions and abrupt clinical deterioration consistent with intracranial hypotension due to shunt over-drainage, which resulted in a fatal cardiopulmonary arrest on the 7 th postoperative day. Conclusion: Our case demonstrates a life-threatening intraperitoneal CSF pseudocyst despite intervention; the patient unfortunately passed away due to postoperative complications, primarily severe intracranial hypotension from shunt over-drainage. Infants with low weight for age, several shunt revisions, and postoperative shunt over-drainage have a poor prognosis; in addition, there are delayed diagnosis, treatment, and limited imaging. The early implementation of alternative methods, along with close postoperative monitoring, can help minimize complications and mortality.
Amin et al. (2026) studied this question.