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Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient
  1. Xiancheng Wu1,
  2. Michael Sandhu1,
  3. Rajat Dhand1,
  4. Leen Alkukhun2 and
  5. Jivan Lamichhane1
  1. 1Medicine, Upstate University Hospital, Syracuse, New York, USA
  2. 2Radiology, Upstate University Hospital, Syracuse, New York, USA
  1. Correspondence to Dr Xiancheng Wu; xiancheng.wu8{at}gmail.com

Abstract

An 89-year-old man with a history of multiple abdominal surgeries and ventriculoperitoneal (VP) shunt placement for normal pressure hydrocephalus presented for intractable abdominal bloating and scrotal swelling, for which imaging revealed massive ascites, bilateral hydrocele and small bilateral pleural effusions. Cardiac, hepatic and renal workup were insignificant. Culture and cytology of ascitic fluid were negative for infection or malignancy. Aetiology of the ascites as secondary to Cerebrospinal fluid (CSF) from the VP shunt was confirmed via ligation of the shunt. Sterile CSF ascites, hydrothorax and hydrocele are rare complications of VP shunt for hydrocephalus and are mostly presented in paediatric patients. We report the first known case of concurrent CSF ascites, hydrothorax and hydrocele in an elderly patient. We examine the difficulty of shunt replacement as a diagnostic and treatment modality in this age group and propose the use of reversible shunt ligation as a diagnostic modality.

  • gastroenterology
  • geriatric medicine
  • hydrocephalus
  • neurosurgery

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Footnotes

  • Contributors XW reviewed the patient’s electronic medical record, reviewed literature and prepared the manuscript. MS and RD reviewed the patient’s electronic medical record and assisted in the preparation and review of the manuscript. LA evaluated and compiled the radiological images, and assisted in the preparation and review of the manuscript. JL supervised the preparation of the manuscript and provided editorial guidance. The patient was under the care of JL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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