Abdominal Complications of Ventriculoperitoneal Shunts in Children (original) (raw)
Related papers
The Open Neuroimaging Journal
Background: Any mismatch between the production and absorption of CSF results in hydrocephalus. In most cases, the selected choice of treatment is the ventriculoperitoneal shunt insertion. Although, the surgery could have complications such as infection, shunt malfunction, subdural hematoma, seizure and Shunt immigration; so, the early and proper detection of these complications could result in better prognosis. The aim of this study was to evaluate and compare the efficacy of CT scan, CSF analysis and X-ray radiography in detection of shunt complications and problems in shunt placement and further follow-up in hospitalized children. Methods: The medical records of children in Rasul Akram hospital in Tehran were reviewed retrospectively in the last 10 years, from 2006 to 2016. All data were recorded in the prepared form including the age, sex, shunt complication, CT scan and CSF characteristics. Results: The total number of 95 patients were interfered in this study including 56 male...
Pamukkale tıp dergisi, 2023
Ventriculoperitoneal shunts are still the mainstay treatment for pediatric hydrocephalus. They have a high complication and failure rate, requiring multiple revisions. In this study, we aim to investigate patients who required shunt replacement without any radiological findings. Material and method: The files of patients under the age of 18, who underwent shunt revision between December 2015 and December 2020 in Bursa Uludag University Medical Faculty Neurosurgery Clinic were reviewed retrospectively. All the radiological studies, laboratory results and clinical conditions of the patients were examined. Results: We identified 127 patients who required a revision of ventriculoperitoneal shunt for suspected mechanical obstruction. 6 patients (5%) had symptoms of raised intracranial pressure, but showed no radiographic evidence of progressive ventricular dilatation. Conclusion: Dysfunction of a ventriculoperitoneal shunt does not always lead to associated radiological alterations. In a patient with signs of intracranial hypertension, revision of the system should be considered even in the absence of progressive ventricular dilatation in radiological studies.
The risk of abdominal operations in children with ventriculoperitoneal shunts
Journal of Pediatric Surgery, 1992
0 Ventriculoperitoneal (VP) shunts are the operations of choice for patients with hydrocephalus in most pediatric hospitals. Children with VP shunts frequently undergo abdominal operations unrelated to their shunts, which might lead to shunt infections or to malfunctions related to adhesions. Although prophylactic antibiotics are usually used in this setting, there are few data to support their use, or to assess other risks to the shunt from the abdominal procedures. Consequently, we reviewed the records of 37 children with VP shunts who underwent a total of 44 abdominal operations. In 8 cases, the genitourinary (GU) tract was opened (ureteral reimplantation, bladder augmentation, nephrectomy), whereas in 18 patients the gastrointestinal (GI) tract was opened (appendectomy, gastrostomy, small/ large bowel resection). In 18 operations neither GI nor GU tract was opened (lysis of adhesions, herniorrhaphy, orchiopexy). Antibiotic coverage was highly variable: 8 received no antibiotics, 9 received antibiotics only postoperatively, 4 were given antibiotics only preoperatively, and in 22 cases antibiotics were given both preoperatively and postoperatively. One shunt that was involved in a periappendiceal abscess was exteriorized and later successfully replaced. In the remaining cases, no episodes of shunt infection or malfunction occurred in 1 to 10 years of follow-up. Likewise, no abdominal cerebrospinal fluid pseudocysts formed as a result of abdominal adhesions. These data demonstrate that children with VP shunts can safely undergo abdominal operations, even when the GI or GU systems are opened, with minimal risk of shunt infection or malfunction.
Management of Postoperative Ventriculoperitoneal Shunt Complications in Pediatric Patients
The Egyptian Journal of Hospital Medicine, 2019
Background: Postoperative ventriculoperitoneal (VP) shunt complications in pediatric patients involves impaired absorption of CSF from the subarachnoid space to the venous circulation via the arachnoid villi. It also involves obstruction in flow of CSF from the ventricles to the subarachnoid space. Objective: To assess the proper management of postoperative shunt complications. Patients and Methods: Retrospective study conducted in the Neurosurgery Department of Al-Azhar University Hospitals and El-Sahel Teaching Hospital. Pediatric patients from both genders including infants and pediatric patients till 12 years old who were having postoperative ventriculoperitoneal shunt complications were assessed clinically and radiographically for the best management that include either surgical or medical ones or both .Results: The management of postoperative VP shunt malfunction is essential shunt revision of either proximal or distal catheters or the whole system if shunt disintegration is suspected. The most common organisms in shunt infection were gram positive organisms (coagulase negative staph. and staph. aureus). Conclusion: The most effective management plan is shunt revision. To prevent VP shunt malfunction, we have to make sure of intraoperative closed, sterile and functioning shunt system.
Ventriculoperitoneal shunt complications: A review
Interdisciplinary Neurosurgery, 2018
Ventriculoperitoneal shunt (VPS) placement is one of the most commonly performed neurosurgical procedures and is necessary to treat most forms of hydrocephalus. Unfortunately, complications related to VPS placement are common, and multiple shunt revisions are almost expected throughout a patient's lifetime. Shunt malfunction may be attributed to multiple causes, including obstruction, infection, pseudocyst formation and bowel perforation. VPS obstruction, which is most often occurs in the proximal catheter, is the most common cause of VPS malfunction. Hardware infection is the second most common cause of VPS malfunction, and this is a complication is most often observed in infants, with premature infants being the most susceptible. Despite continuous attempts to reduce the incidence of VPS complications, such as improved sterile techniques, antibiotic impregnated catheters, and programmable valves, VPS malfunction remains a major problem, which often leads to multiple and costly hospital admissions. In the present review, the most common complications of VPS are discussed, including presentation and appropriate management.
Cureus
Ever since the shunt device became the gold standard treatment for hydrocephalus, complications due to infections and mechanical problems have increased while lives have been saved. In addition, abdominal complications have become an important issue as the peritoneum is now the main place to insert the distal catheter. The most common complications were abdominal pseudocyst, distal catheter migration, inguinal hernia, catheter disconnection, and intestinal obstruction. The pediatric population is more prone to develop most of these complications due to their rapidly growing body, weaker abdominal musculature, and increased intraabdominal pressure. The goal of this review was to study the main aspects associated with abdominal complications after ventriculoperitoneal shunt (VPS) insertion, including the pathophysiology, epidemiological aspects, as well as the rationale for management and prevention according to the current "state-of-the-art." It is paramount to recognize the risk factors associated with various types of complications to manage them properly.
Cerebrospinal fluid ascites: a complication of a ventriculoperitoneal shunt
2016
SUMMARY A 1 year old Caucasian male born with an omphalocoele, malrotation of the large bowel, and Ladd's bands developed an E. coli wound infection and subsequent meningitis-ventricu-litis which responded to antibiotic therapy. Aqueductal stenosis and obstructive hydrocephalus initially was treated with a ventriculoperitoneal shunt. After a routine diphtheria-pertussis-tetanus immunization, the child developed a CSF ascites which resolved following a ventriculoatrial shunt. Large abdominal cysts have been reported as a complication of ventriculoperitoneal shunts
Pediatric emergency care, 2016
The evaluation of children with suspected ventriculoperitoneal shunt (VPS) malfunction has evolved into a diagnostic dilemma. This patient population is vulnerable not only to the medical risks of hydrocephalus and surgical complications but also to silent but harmful effects of ionizing radiation secondary to imaging used to evaluate shunt efficacy and patency. The combination of increased medical awareness regarding ionizing radiation and public concern has generated desire to reduce the reliance on head computed tomography (CT) for the evaluation of VPS malfunction. Many centers have started to investigate the utility of low-dose CT scans and alternatives, such as fast magnetic resonance imaging for the investigation of VP shunt malfunction in order to keep radiation exposure as low as reasonably achievable. This pilot study hopes to add to the armamentarium available to the clinician charged with evaluating this challenging patient population by testing the feasibility of a limi...
Ventriculoperitoneal shunt malfunction: Presentation of 2 case reports and review of the literature
Journal of Dr Behcet Uz Children's Hospital, 2013
This study was carried out to focus on two unusual complications due to ventriculoperitoneal shunts (VPSs) performed in hydrocephalic children. Management of these patients with a special emphasis on the foregoing literature concerning the migration of shunt catheter into the scrotum is reviewed and discussed. Methods: A retrospective clinical study performed in patients with complications of VPS causing acute abdomino-scrotal conditions in two different centers between 2002-2012 is presented in the current study. Results: There are two pediatric cases with diagnosis of hydrocephaly and complications of VPS during the study period. Age, mode of presentation, results of treatment were studied. Apart from physical examination and radiological investigations, diagnosis of VPS complication was confirmed during surgical procedures in our patients. Conclusion: Complications of intestinal obstruction and protrusion of the VPS catheter into the scrotum are rarely seen in hydrocephalic children with VPS. Early identification and management of these complications is recommended for that they may cause life-threatening acute abdomino-scrotal conditions. ÖZET Amaç: Bu çalışmada hidrosefalik çocuklarda ventriküloperitoneal şant (VPŞ) uygulamasına ait alışık olunmayan iki komplikasyon sunulmuştur. Bu çocukların yönetimi özellikle şant kateterinin skrotal migrasyonuna ilişkin literatürler ışığında değerlendirilip tartışılmıştır. Yöntemler: Bu retrospektif kesitsel çalışmada iki ayrı merkezde 2002 ile 2012 yılları arasında akut abdomen ve akut skrotal şişme tablosu oluşturan VPŞ komplikasyonlu olgular sunularak tartışılmıştır. Bulgular: Çalışma dönemi içerisinde hidrosefali tanısı almış ve VPŞ komplikasyonu gelişmiş iki olgu bulunmaktadır. Yaş, klinik yansıma şekli, tedavi sonuçları çalışılmıştır. Fizik muayene ve radyolojik görüntüleme yöntemleri dışında VPŞ komplikasyon tanısı cerrahi tedavi sırasında doğrulanmıştır. Sonuç: Hidrosefalik VPŞ kateterli olgularda intestinal obstrüksiyon ve şant kateterinin skrotuma protrüzyonu nadiren görülür. Yaşamı tehdit edebilen akut abdominoskrotal durumlar oluşturabileceğinden bu komplikasyonların erken tanı ve tedavisi önerilmektedir.