Aseptic Ascites: A Rare and Challenging Complication of Ventriculoperitoneal Shunting

Abstract

Introduction: Ventriculoperitoneal (VP) shunts are widely used to manage hydrocephalus providing significant relief from cerebrospinal fluid (CSF) accumulation. However, abdominal complications, such as aseptic ascites, can occur, albeit rarely. This condition is characterized by the diffuse accumulation of CSF in the peritoneal cavity without evidence of infection, often requiring specific interventions.

Case presentation: We present the case of a 3-year-old child with abdominal distension for the past 15 days, without other abnormalities. The child was in the late postoperative period for optic pathway pilocytic astrocytoma, with surgeries performed at 1 year and 7 months of age and VP shunt (VPS) placement at 1 year and 10 months of age. Abdominal ultrasound, computed tomography, and magnetic resonance imaging revealed large-volume ascites without additional findings. Diagnostic paracentesis showed a serum-ascites albumin gradient (SAAG) of 3.1. Biochemical and microbiological analyses showed no signs of infection, and liver, cardiac, and renal function markers were within normal ranges. Cytological analysis revealed no neoplastic cells. A ventriculoatrial shunt was placed, resolving the ascites.

Conclusions: Aseptic ascites is a rare dysfunction of VPS, with limited cases reported. Most cases of peritoneal fluid accumulation are associated with shunt infections resulting in peritonitis. In aseptic ascites, however, microbiological analysis of ascitic fluid was negative. Intracranial hypertension symptoms are not usual - typically, the main symptom is abdominal distension without signs of peritonitis. Owing to the high protein accumulation and CSF production in certain conditions, ventriculoatrial shunting is commonly chosen as an alternative.