Quek SXZ, Ching KWJ, Mangat K, Low HC, Ko SQ. Cerebrospinal fluid pseudocyst presenting as ascites: A case report. World J Hepatol 2025; 17(12): 113157 [DOI: 10.4254/wjh.v17.i12.113157]
Corresponding Author of This Article
Sabrina Xin Zi Quek, Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. sabrinaquek@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Dec 27, 2025; 17(12): 113157 Published online Dec 27, 2025. doi: 10.4254/wjh.v17.i12.113157
Cerebrospinal fluid pseudocyst presenting as ascites: A case report
Sabrina Xin Zi Quek, Keith Wei Jie Ching, Kamarjit Mangat, How Cheng Low, Stephanie Qianwen Ko
Sabrina Xin Zi Quek, How Cheng Low, Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, Singapore 119074, Singapore
Keith Wei Jie Ching, Stephanie Qianwen Ko, Department of Medicine, National University Hospital, Singapore 119074, Singapore
Kamarjit Mangat, Department of Radiology, National University Hospital, Singapore 119074, Singapore
Co-corresponding authors: Sabrina Xin Zi Quek and Stephanie Qianwen Ko.
Author contributions: Quek SXZ and Ko SQ conceived the case report and jointly oversaw its development; Quek SXZ and Ching KWJ drafted the initial manuscript, while Ko SQ supervised the clinical and academic aspects of the work and provided in-depth critical revisions; Mangat K and Low HC contributed essential clinical management and expert interpretation; Quek SXZ and Ko SQ served as co-corresponding authors because both played indispensable and complementary roles; Quek SXZ coordinated case synthesis, conducted the literature review, prepared successive manuscript drafts, and facilitated communication among authors, while Ko SQ provided senior clinical oversight, guided diagnostic and management interpretation, and ensured scientific rigor and coherence of the final manuscript; All authors contributed to manuscript refinement and approved the final version for submission.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sabrina Xin Zi Quek, Department of Medicine, Division of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. sabrinaquek@gmail.com
Received: August 18, 2025 Revised: September 3, 2025 Accepted: November 26, 2025 Published online: December 27, 2025 Processing time: 132 Days and 1.7 Hours
Abstract
BACKGROUND
Cerebrospinal 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.
CASE SUMMARY
A 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.
CONCLUSION
Persistent diagnostic uncertainty requires broad clinical suspicion and selective testing to identify rare causes of ascites.
Core 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.
