Abstract
Purpose
The aim of this study was to describe our experience in the management of patients with ventriculoperitoneal shunt–related complications (abdominal pseudocyst, bowel-related complications, and ascites) and to propose treatment recommendations.
Material and methods
A retrospective descriptive study was conducted in patients with ventriculoperitoneal shunt–related abdominal complications seen between 2009 and 2019 at a tertiary-care pediatric center. Patients were classified according to their diagnosis into the following: group A (abdominal pseudocyst), group B (bowel-related complications), and group C (ascites). The following variables were studied in all three groups: age, sex, etiology of hydrocephalus, history of pyogenic ventriculitis, history of abdominal surgery, clinical presentation, presence of ventricular enlargement on computed tomography scan, abdominal ultrasonography, shunt series X-ray, cerebrospinal fluid cultures, urgent as well as elective surgical interventions, antibiotic treatment, length of hospital stay, follow-up, and outcome.
Results
Overall, 48 patients were analyzed: group A, n=29; group B, n=15; and group C, n=4. In all cases, surgical decision-making was based on symptom severity at the time of diagnosis, presence of ventricular enlargement on computed tomography scan, and cerebrospinal fluid culture results. In patients with positive cultures, the shunt system was removed, and an external ventricular drain was placed. In oligosymptomatic patients, cerebrospinal fluid culture results were awaited to define long-term treatment and in patients with ventricular enlargement or clinically difficult-to-treat symptoms, the distal catheter was exteriorized at the thoracic level.
Conclusion
In patients with shunt-related abdominal complications, surgical management depends on symptom severity and/or whether infection is present at the time of diagnosis.
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References
Hamid R, Baba AA, Bhat NA et al (2017) Post ventriculoperitoneal shunt abdominal pseudocyst: challenges posed in management. Asian J Neurosurg 12:13–16
Popa F, Grigorean VT, Onose G et al (2009) Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt. J Med Life 2:426–436
Goodman GM, Gourley GR (1988) Ascites complicating ventriculoperitoneal shunts. J Pediatr Gastroenterol Nutr 7:780–782
Ivan Y, Hauptman J, Marin JR (2016) Abdominal cerebrospinal fluid pseudocyst diagnosed by point-of-care ultrasound. Pediatr Emerg Care 32:408–409
Sebastian M, Sebastian A, Sroczyński M, Rudnicki J (2018) Laparoscopic management of abdominal pseudocyst following ventriculoperitoneal shunt implantation in hydrocephalus. Wideochir Inne Tech Maloinwazyjne 13:260–265
Guest BJ, Merjanian MH, Chiu EF, Canders CP (2019) Abdominal cerebrospinal fluid pseudocyst diagnosed with point-of-care ultrasound. Clin Pract Cases Emerg Med 3:43–46
Burhan B, Serdar KB, Abdurrahman A et al (2018) Abdominal complications of ventriculoperitoneal shunt in pediatric patients: experiences of a pediatric surgery clinic. World Neurosurg 118:e129–e136
Ayan E, Tanriverdi HI, Caliskan T et al (2015) Intraabdominal pseudocyst developed after ventriculoperitoneal shunt: a case report. J Clin Diagn Res 9:PD05–PD06
Dabdoub CB, Dabdoub CF, Chavez M et al (2014) Abdominal cerebrospinal fluid pseudocyst: a comparative analysis between children and adults. Childs Nerv Syst 30:579–589
de Oliveira RS, Barbosa A, Vicente YA d MV d A, Machado HR (2007) An alternative approach for management of abdominal cerebrospinal fluid pseudocysts in children. Childs Nerv Syst 23:85–90
Kariyattil R, Steinbok P, Singhal A, Cochrane DD (2007) Ascites and abdominal pseudocysts following ventriculoperitoneal shunt surgery: variations of the same theme. J Neurosurg 106:350–353
Dzongowski E, Coriolano K, de Ribaupierre S, Jones SA (2017) Treatment of abdominal pseudocysts and associated ventriculoperitoneal shunt failure. Childs Nerv Syst 33:2087–2093
Hinojosa J (2015) Complications of peritoneal shunts. In: Di Rocco C, Turgut M, Jallo G, Martínez-Lage JF (eds) Complications of CSF shunting in hydrocephalus: prevention, identification, and management. Springer International Publishing, Cham, pp 187–202
Gmeiner M, Wagner H, van Ouwerkerk WJR et al (2018) Abdominal pseudocysts and peritoneal catheter revisions: surgical long-term results in pediatric hydrocephalus. World Neurosurg 111:e912–e920
Koide Y, Osako T, Kameda M et al (2019) Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report. J Med Case Rep 13:361
Kashyap S, Ghanchi H, Minasian T et al (2017) Abdominal pseudocyst as a complication of ventriculoperitoneal shunt placement: review of the literature and a proposed algorithm for treatment using 4 illustrative cases. Surg Neurol Int 8:78
Kurin M, Lee K, Gardner P et al (2017) Clinical peritonitis from allergy to silicone ventriculoperitoneal shunt. Clin J Gastroenterol 10:229–231
Mobley LW 3rd, Doran SE, Hellbusch LC (2005) Abdominal pseudocyst: predisposing factors and treatment algorithm. Pediatr Neurosurg 41:77–83
Gaskill SJ, Marlin AE (1989) Pseudocysts of the abdomen associated with ventriculoperitoneal shunts: a report of twelve cases and a review of the literature. Pediatr Neurosci 15:23–26 discussion 26–7
Yuh S-J, Vassilyadi M (2012) Management of abdominal pseudocyst in shunt-dependent hydrocephalus. Surg Neurol Int 3:146
Dalfino JC, Adamo MA, Gandhi RH et al (2012) Conservative management of ventriculoperitoneal shunts in the setting of abdominal and pelvic infections. J Neurosurg Pediatr 9:69–72
Pumberger W, Löbl M, Geissler W (1998) Appendicitis in children with a ventriculoperitoneal shunt. Pediatr Neurosurg 28:21–26
Johnstone PD, Jayamohan J, Kelly DF, Drysdale SB (2019) Does appendicitis in a child with a ventriculoperitoneal shunt necessitate shunt revision? Arch Dis Child 104:607–609
Bavdekar A, Thakur N (2016) Ascites in Children. Indian J Pediatr 83:1334–1340
West GA, Berger MS, Geyer JR (1994) Childhood optic pathway tumors associated with ascites following ventriculoperitoneal shunt placement. Pediatr Neurosurg 21:254–258 discussion 259
Gil Z, Beni-Adani L, Siomin V et al (2001) Ascites following ventriculoperitoneal shunting in children with chiasmatic-hypothalamic glioma. Childs Nerv Syst 17:395–398
Häussler B, Menardi G, Hausberger K, Hager J (2001) Ventriculoperitoneal shunt infection and appendicitis in children. Eur J Pediatr Surg 11(Suppl 1):S55–S56
Coley BD, Shiels WE 2nd, Elton S, Murakami JW, Hogan MJ (2004) Sonographically guided aspiration of cerebrospinal fluid pseudocysts in children and adolescents AJR. Am J Roentgenol 183:1507–1151
Sanal M, Laimer E, Haussler B, Hager J (2007) Abdominal cerebrospinal fluid pseudocysts in patients with ventriculoperitoneal shunt: 30 years of experience. J Indian Assoc Pediatric Surg 12:214–217 104
Barina AR, Virgo KS, Mushi E et al (2007) Appendectomy for appendicitis in patients with a prior ventriculoperitoneal shunt. J Surg Res 141:40–44
Aparici-Robles F, Molina-Fabrega R (2008) Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults. J Med Imaging Radiat Oncol 52:40–43
Nfonsam V, Chand B, Rosenblatt S, Turner R, Luciano M (2008) Laparoscopic management of distal ventriculoperitoneal shunt complications. Surg Endosc 22:1866–1870
Salomão JF, Leibinger RD (1999) Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases. Pediatr Neurosurg 31:274–278
Ozdol C, Gediz T, Basak AT et al (2019) Shunt tapping versus lumbar puncture for evaluating cerebrospinal fluid infections in a pediatric population. Turk Neurosurg 29:275–278
Tunkel AR, Hasbun R, Bhimraj A et al (2017) 2017 Infectious Diseases Society of America’s Clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis 64:e34–e65
Kulkarni AV, Drake JM, Kestle JRW et al (2010) Predicting who will benefit from endoscopic third ventriculostomy compared with shunt insertion in childhood hydrocephalus using the ETV Success Score. J Neurosurg Pediatr 6:310–315
Yount RA, Glazier MC, Mealey J Jr, Kalsbeck JE (1984) Cerebrospinal fluid ascites complicating ventriculoperitoneal shunting. Report of four cases. J Neurosurg 61:180–183
Matsushita S (2017) How to perform a ventriculopleural shunt. In: Di Rocco C, Pang D, Rutka JT (eds) Textbook of Pediatric Neurosurgery. Springer International Publishing, Cham, pp 1–8
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Basilotta Márquez, Y.N.I., Mengide, J.P., Liñares, J.M. et al. Abdominal complications in patients with a ventriculoperitoneal shunt: proposal for management recommendations from a single pediatric tertiary center. Childs Nerv Syst 37, 2223–2232 (2021). https://doi.org/10.1007/s00381-021-05121-y
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DOI: https://doi.org/10.1007/s00381-021-05121-y