Laparoscopic-assisted revision of a distal catheter after laparoscopic-assisted ventriculoperitoneal shunting complicated by an abdominal pseudocyst: a case report

Background Laparoscopic assistance can facilitate accurate placement and revision of the distal catheter in ventriculoperitoneal shunt (VPS) surgery. However, the management of distal catheter complications after prior laparoscopic-assisted VPS, particularly when the catheter has been fixed to the falciform ligament, is rarely described. On postoperative day 1, the patient was able to open his eyes spontaneously. Neurological examination showed flexion responses of both limbs to painful stimulation. Before surgery, painful stimulation did not induce eye opening; the left limb showed a flexion response to painful stimulation, whereas the right limb showed no response. The Glasgow Coma Scale (GCS) score was 5T before surgery (E1VTM4) and improved to 8T (E4VTM4). Both assessments were performed while the patient remained tracheostomized. Overall, the postoperative neurological examination demonstrated improvement in both consciousness and motor responses. Conclusion This case highlights a rare combination of abdominal pseudocyst formation, distal catheter fixation to the falciform ligament, and CSF leakage through a previous abdominal incision. Laparoscopic visualization may facilitate identification of the catheter, adhesions, fixation point, and catheter patency during revision. The case also suggests that fixation techniques should be selected with attention to both catheter stability and the potential difficulty of subsequent revision. Because this is a single case with limited follow-up, the causal contribution of falciform-ligament fixation to pseudocyst formation cannot be established.