Intra-abdominal cystic lesions after ventriculoperitoneal shunting

Yıl 2023, Cilt: 9 Sayı: 1, 49 - 56, 04.01.2023

Elif Başaran Gündoğdu , Esra Ozcakir

https://doi.org/10.18621/eurj.1084900

Öz

Objectives: Definitive diagnosis is essential for the medical and surgical management of pediatric patients with ventriculoperitoneal (VP) shunt. In patients with a VP shunt, abdominal complications have been well described, among which abdominal pseudo cysts are uncommon. In this report, we present our experience in terms of the multi-disciplinary management of intra-abdominal cystic lesions associated with the VP shunt procedure. 

Methods: From 2016 to 2021, 245 VP shunt procedures were performed in our institution. Intra-abdominal cystic lesions were recorded as intra-abdominal complications (abdominal pseudocyst, intestinal subserosal bowel cyst, and scrotal cyst) in 3 patients. For these patients we retrospectively collected data on medical history, complaints, diagnosis, treatment procedure, and postoperative results. The study was performed on 2 male and 1 female patients. The average patient age was 11.6 months (5 months to 1.5 years). The most common complaint was that of abdominal distention with ileus symptoms. The average time of admission after the catheterization of VP shunt was 1 month; laparotomy was performed for 2 patients in whom treatment was needed for high ligation. 

Results: A VP shunt operation is followed by abdominal complications in about 5%-47% of all cases. These complications are manifested as ileus symptoms, such as vomiting, abdominal distension, and abdominal pain with intestinal obstruction. 

Conclusions: In pediatric patients with VP shunts, a shunt catheter-induced abdominal cystic formation should always be considered a complication. Management of these cystic lesions requires the use of a multi-disciplinary approach with neurosurgery and pediatric surgery for treatment.

Anahtar Kelimeler

Intra-abdominal cyst, ventriculoperitoneal shunt, hydrocephalus

Kaynakça

• 1. Drake JM, Kestle JR, Tuli S. CSF shunts 50 years on – past, present and future. Childs Nerv Syst 2000;16:800-4.
• 2. Shahi MV, Noorbakhsh S, Zarrabi V, Nourozi B,Tahernia L. The neuroimaging studies in children with ventriculoperitoneal shunt complications: a 10 years descriptive study in Tehran. Open Neuroimag J 2018;12:1-9.
• 3. Kashyap S, Ghanchi H, Minasian T, Dong F, Miulli D. 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 2017;8:78.
• 4. Mobley LW 3rd, Doran SE, Hellbusch LC. Abdominal pseudocyst: predisposing factors and treatment algorithm. Pediatr Neurosurg 2005;41:77-83.
• 5. Chung JJ, Yu JS, Kim JH, Nam SJ, Kim MJ. Intraabdominal complications secondary to ventriculoperitoneal shunts: CT findings and review of the literature. AJR Am J Roentgenol 2009;193:1311-7.
• 6. Yuh SJ, Vassilyadi M. Management of abdominal pseudocyst in shunt dependent hydrocephalus. Surg Neurol Int 2012;3:146.
• 7. Van Heurn LW, Pakarinen MP, Wester T. Contemporary management of abdominal surgical emergencies in infants and children. Br J Surg. 2014;101:e24-33.
• 8. Sanan A, Haines SJ, Nyberg SL, Leonard AS. Knotted bowel: small-bowel obstruction from coiled peritoneal shunt catheters. Report of two cases. J Neurosurg 1995;82:1062-4.
• 9. Starreveld Y, Poenaru D, Ellis P. Ventriculoperitoneal shunt knot: a rare cause of bowel obstruction and ischemia. Can J Surg 1998;41:239-40.
• 10. Dabdoub CB, Dabdoub CF Chavez M, Villarroel J, Ferrufino JL, Coimbra A, et al. Abdominal cerebrospinal fluid pseudocyst: a comparative analysis between children and adults. Child Nerv Syst 2014;30:579-89.
• 11. Sharifa AD. Ventriculoperitoneal shunt with communicating peritoneal & subcutaneous pseudocysts formation. Int J Health Sci (Qassim) 2014;8:107-11.
• 12. Pathi R, Sage M, Slavotinek J, Hanieh A. Abdominal cerebrospinal fluid pseudocyst. Australas Radiol 2004;48:61-3.
• 13. Ersahin Y, Mutluer S, Guzelbag E. Cerebrospinal fluid shunt infections. J Neurosurg Sci 1994;38:161-5.
• 14. Hamid R, Baba AA, Bhat NA, Mufti G, Mir YA, Sajad W. Post ventriculoperitoneal shunt abdominal pseudocyst: Challenges posed in management. Asian J Neurosurg 2017;12:13-6.
• 15. Hahn YS, Engelhard H, McLone DG. Abdominal CSF pseudocyst. Clinical features and surgical management. Pediatr Neurosci 1985;12:75-9.
• 16. Egelhoff J, Babcock DS, McLaurin R. Cerebrospinal fluid pseudocysts: Sonographic appearance and clinical management. Pediatr Neurosci 1985;12:80-6.
• 17. Agha FP, Amendola MA, Shirazi KK, Amendola BE, Chandler WF. Unusual abdominal complications of ventriculo peritoneal shunts. Radiology 1983;146:323-6.
• 18. Norton J, Bollinger RR, Chang AE, Lowry SF. Surgery: Basic Science and Clinical Evidence. Springer, 2012: 560.
• 19. Kim HB, Raghavendran K, Kleinhaus S. Management of an abdominal cerebrospinal fluid pseudocyst using laparoscopic techniques. Surg Laparosc Endosc 1995;5:151-4.
• 20. Raffa G, La Torre D, Conti A, Cardali SM, Angileri FF, Germanò A. The efficacy of 90 cm-long peritoneal shunt catheters in newborns and infants. J Neurosurg Sci 2017;61:33-8.