{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T14:05:08Z","timestamp":1768485908617,"version":"3.49.0"},"reference-count":17,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,24]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2021-242593","type":"journal-article","created":{"date-parts":[[2021,7,26]],"date-time":"2021-07-26T12:41:14Z","timestamp":1627303274000},"page":"e242593","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Sterile cerebrospinal fluid ascites, hydrothorax and hydrocele as a complication of ventriculoperitoneal shunting in an elderly patient"],"prefix":"10.1136","volume":"14","author":[{"given":"Xiancheng","family":"Wu","sequence":"first","affiliation":[{"name":"Medicine, Upstate University Hospital, Syracuse, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6200-5083","authenticated-orcid":false,"given":"Michael","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Medicine, Upstate University Hospital, Syracuse, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajat","family":"Dhand","sequence":"additional","affiliation":[{"name":"Medicine, Upstate University Hospital, Syracuse, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leen","family":"Alkukhun","sequence":"additional","affiliation":[{"name":"Radiology, Upstate University Hospital, Syracuse, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jivan","family":"Lamichhane","sequence":"additional","affiliation":[{"name":"Medicine, Upstate University Hospital, Syracuse, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,7,26]]},"reference":[{"key":"2025082709001904000_14.7.e242593.1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-319927"},{"key":"2025082709001904000_14.7.e242593.2","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.inat.2018.04.004","article-title":"Ventriculoperitoneal shunt complications: a review","volume":"13","author":"Paff","year":"2018","journal-title":"Interdisciplinary Neurosurgery"},{"key":"2025082709001904000_14.7.e242593.3","doi-asserted-by":"publisher","DOI":"10.1080\/02699050410001671793"},{"key":"2025082709001904000_14.7.e242593.4","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1227\/00006123-199103000-00014","article-title":"Endoscopic coagulation of the choroid plexus using the Nd:YAG laser: initial experience and proposal for management","volume":"28","author":"Bucholz","year":"1991","journal-title":"Neurosurgery"},{"key":"2025082709001904000_14.7.e242593.5","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1007\/BF02730585","article-title":"Ascites in ventriculoperitoneal shunt","volume":"70","author":"Kumar","year":"2003","journal-title":"Indian J Pediatr"},{"key":"2025082709001904000_14.7.e242593.6","doi-asserted-by":"publisher","DOI":"10.1159\/000076575"},{"key":"2025082709001904000_14.7.e242593.7","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.1007\/s00381-009-0923-6","article-title":"Bilateral choroid plexus hyperplasia: a case report and management strategies","volume":"25","author":"Warren","year":"2009","journal-title":"Childs Nerv Syst"},{"key":"2025082709001904000_14.7.e242593.8","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.35.4.474"},{"key":"2025082709001904000_14.7.e242593.9","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1055\/s-2007-1025515","article-title":"[Massive ascites formation due to unabsorbed cerebrospinal fluid following abdominal surgery in ventriculoperitoneal shunt. 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