Introduction: Cerebrospinal fluid (CSF) ascites is a rare complication of ventriculoperitoneal shunt (VPS) surgery that commonly results from infection and peritonitis. We report sterile CSF ascites in a VPS patient secondary to CSF overproduction in choroid plexus hyperplasia that resolved with conversion to a ventriculoatrial shunt (VAS).
Methods: A 2-year-old female with multiple congenital anomalies and a VPS for choroid plexus hyperplasia and communicating hydrocephalus presented in acute hypoxic respiratory distress that required mechanical ventilation. At 4 months of age, she was managed with a subdural-peritoneal shunt, which was converted to a VPS at 8 months of age. A MRI scan of the brain revealed choroid plexus hyperplasia of the lateral ventricles. At 2-years of age, she presented with acute respiratory failure secondary to Influenza B infection and an enlarged abdomen. CT scan of the head revealed stable ventricular size, and her shunt series study was normal. A shunt tap of the reservoir performed by neurosurgery demonstrated a functioning shunt, with no signs of infection. An abdominal ultrasound demonstrated massive simple ascites.
Results: A peritoneal drain was placed for lack of respiratory improvement, and 1.5 liters of clear fluid was drained. The fluid was transudate in nature, with negative cultures. Following drain placement, she demonstrated significant improvement in her respiratory status and was weaned off the mechanical ventilator. Clamping of her peritoneal drain was associated with abdominal distention and re-accumulation of ascites. In order to reduce this burden, the patient’s VPS was converted to a VAS. She was then able to be extubated, and there was no further ascites development.
Conclusions: It may be reasonable to consider a VAS in infants with communicating hydrocephalus secondary to choroid plexus hyperplasia as a primary treatment of choice.
Patient Care: Provide an alternative treatment for choroid plexus hyperplasia in the setting of sterile CSF ascites
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of considering a VAS in infants with choroid plexus hyperplasia. 2) Discuss, in small groups, the clinical course of patients with choroid plexus hyperplasia. 3) Identify an effective treatment for patients with a VPS who develop sterile CSF ascites.