[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-406767-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-406767-en":131},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","cerebrospinal-fluid-pseudocyst-presenting-as-ascites-a-case-report","Cerebrospinal fluid pseudocyst presenting as ascites - A case report","","Cerebrospinal fluid (CSF) pseudocysts are uncommon complications of ventriculoperitoneal (VP) shunts, usually appearing within 3 weeks to 10 years after insertion. A perihepatic CSF pseudocyst developed over 27 years after shunt placement, markedly delayed compared with prior reports. The case underscores maintaining diagnostic openness in unexplained ascites and shows how beta-2 transferrin testing of drained fluid can confirm a rare etiology when imaging is non-contributory.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/cerebrospinal-fluid-pseudocyst-presenting-as-ascites-a-case-report/406767/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/cerebrospinal-fluid-pseudocyst-presenting-as-ascites-a-case-report/406767.png","ImageObject",300,407,{"name":42,"@type":43},"Bulrr","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-02","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",11,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why is the reported CSF pseudocyst notable?","Question",{"text":63,"@type":64},"It developed more than 27 years after ventriculoperitoneal shunt placement, representing an exceptionally long interval compared with previously reported cases.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the diagnosis confirmed when imaging did not reveal the shunt?",{"text":68,"@type":64},"Clinicians reassessed the case for CSF origin and confirmed a CSF pseudocyst by beta-2 transferrin testing of the drained perihepatic fluid.",{"name":70,"@type":61,"acceptedAnswer":71},"What treatment led to resolution of symptoms?",{"text":72,"@type":64},"The patient underwent VP shunt exploration and revision with relocation to the pleural space, resolving the abdominal fluid collections and associated symptoms.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},406767,1790803968,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,120,123,127],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":116,"doc_module":4,"doc_module_name":25,"category_name":117,"show_sort_weight":118,"slug":119},9,"Religion & Spirituality",20,"religion-spirituality",{"id":118,"doc_module":4,"doc_module_name":25,"category_name":121,"show_sort_weight":118,"slug":122},"World Cup","world-cup",{"id":124,"doc_module":4,"doc_module_name":25,"category_name":125,"show_sort_weight":124,"slug":126},10,"Lifestyle","lifestyle",{"id":128,"doc_module":4,"doc_module_name":25,"category_name":129,"show_sort_weight":97,"slug":130},19,"General","general",{"code":4,"msg":82,"data":132},{"doc_id":79,"user_id":133,"nickname":42,"user_avatar":134,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":111,"language":140,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":12,"update_tm":144,"read_time":118,"preview_page_count":4},5909892115043,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","| W | J | H | World Journal of\u003Cbr>Hepatology |\n| --- | --- | --- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Hepatol 2025 December 27; 17(12): 113157  \nDOI: 10.4254/wjh.v17.i12.113157 ISSN 1948-5182 (online)  \nCASE REPORT  \nCerebrospinal fluid pseudocyst presenting as ascites: A case report  \nSabrina Xin Zi Quek, Keith Wei Jie Ching, Kamarjit Mangat, How Cheng Low, Stephanie Qianwen Ko  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nUnsolicited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade C  \nNovelty: Grade C  \nCreativity or Innovation: Grade C  \nScientific Significance: Grade C  \nP-Reviewer: Cheng JW, PhD,  \nAdjunct Associate Professor, China  \nReceived: August 18, 2025  \nRevised: September 3, 2025  \nAccepted: November 26, 2025  \nPublished online: December 27, 2025  \nProcessing time: 131 Days and 20.8 Hours  \nSabrina Xin Zi Quek, How Cheng Low, Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore 119074, Singapore  \nKeith Wei Jie Ching, Stephanie Qianwen Ko, Department of Medicine, National University Hospital, Singapore 119074, Singapore  \nKamarjit Mangat, Department of Radiology, National University Hospital, Singapore 119074, Singapore  \nCo-corresponding authors: Sabrina Xin Zi Quek and Stephanie Qianwen Ko.  \nCorresponding author: Sabrina Xin Zi Quek, Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, [Singapore.](Singapore. sabrinaquek@gmail.com)[ sabrinaquek@gmail.com](Singapore. sabrinaquek@gmail.com)  \nAbstract  \nBACKGROUND  \nCerebrospinal fluid (CSF) pseudocysts are uncommon complications of ventriculoperitoneal (VP) shunts, usually occurring within 3 weeks to 10 years of insertion. We report a perihepatic CSF pseudocyst presenting over 27 years after shunt placement, representing an exceptionally long interval compared with prior reports. This case highlights the importance of maintaining diagnostic openness when investigating unexplained ascites, and demonstrates the role of fluid beta-2 transferrin in confirming a rare diagnosis.  \nCASE SUMMARY  \nA 42-year-old man with spina bifida and prior VP shunt insertion was admitted for urinary tract infection, later developing recurrent symptomatic perihepatic fluid collections. Extensive hepatic, cardiac, and surgical evaluations were unremarkable, and repeated percutaneous drainages failed. The possibility of CSF origin was raised after clinical reappraisal, and beta-2 transferrin testing of the drained fluid confirmed a CSF pseudocyst. The patient underwent VP shunt exploration and revision with relocation to the pleural space, leading to resolution of the abdominal collections and symptoms.  \nCONCLUSION  \nPersistent diagnostic uncertainty requires broad clinical suspicion and selective testing to identify rare causes of ascites.  \nKey Words: Cerebrospinal fluid pseudocyst; Beta-2 transferrin; Ventriculoperitoneal shunt; Ascites; Case report  \n WJH  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 27, 2025  Volume 17  Issue 12   \nQuek SXZ et al. CSF pseudocyst presenting as ascites  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \nCore Tip: Recurrent perihepatic “ascites” in a patient with spina bifida was resistant to exhaustive hepatic, cardiac, and surgical evaluation. The eventual diagnosis—a cerebrospinal fluid pseudocyst from a 27-year-old ventriculoperitoneal shunt—was made possible by renewed clinical suspicion and targeted beta-2 transferrin testing, despite the shunt being invisible on imaging. This case highlights the need to keep rare diagnoses in mind when standard workups fail, and the role of selective, specific tests in solving complex diagnostic puzzles.  \nCitation: Quek SXZ, Ching K","cbCaib8RjD3GRsDX","https://ap.wps.com/l/cbCaib8RjD3GRsDX","pdf",4580057,"English","# Abstract\n## Background\n## Case Summary\n## Conclusion\n# Introduction\n# Chief complaints\n# History of present illness\n# History of past illness","[{\"question\":\"Why is the reported CSF pseudocyst notable?\",\"answer\":\"It developed more than 27 years after ventriculoperitoneal shunt placement, representing an exceptionally long interval compared with previously reported cases.\"},{\"question\":\"How was the diagnosis confirmed when imaging did not reveal the shunt?\",\"answer\":\"Clinicians reassessed the case for CSF origin and confirmed a CSF pseudocyst by beta-2 transferrin testing of the drained perihepatic fluid.\"},{\"question\":\"What treatment led to resolution of symptoms?\",\"answer\":\"The patient underwent VP shunt exploration and revision with relocation to the pleural space, resolving the abdominal fluid collections and associated symptoms.\"}]","Cerebrospinal fluid pseudocyst presenting as ascites - A case report | PDF",1790567735]