Letter to the Editor. Ventriculoperitoneal shunts after abdominal surgery (original) (raw)
Abdominal Complications of Ventriculoperitoneal Shunts in Children
Seminars in Ultrasound, CT and MRI, 2006
Ventricular peritoneal cerebrospinal fluid shunting has become a common pediatric neurosurgical procedure over the last 40 years. While invaluable for these patients, shunts are prone to complications, especially in children. Abdominal complications are often secondary to infection and its complications, and may be difficult to recognize in these medically complex children. Imaging is often required, but the findings may be subtle and require an appreciation of the spectrum of possible abnormalities. This article reviews the imaging findings present with abdominal shunt complications. Semin Ultrasound CT MRI 27:152-160
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.
Analysis of factors affecting ventriculoperitoneal shunt survival in pediatric patients
Child's Nervous System, 2013
Purpose Management of hydrocephalus with insertion of ventriculoperitoneal (VP) shunt is associated with significant complications in both adult and pediatric patients. These may be more common in developing countries due to poor economic conditions and a dearth of available resources. We report a 6 years' experience with VP shunt insertion in pediatric patients from a developing country, focusing particularly on factors affecting shunt failure. Methods Patients aged below 15 years, who had undergone insertion of VP shunts for hydrocephalus during the years 2006 to 2011, were included. A retrospective analysis of shunt survival was performed using Kaplan-Meier curves and Logrank (Cox-Mantel) test. Results Among the total 113 patients, the most common etiologies of hydrocephalus were congenital hydrocephalus (19.5 %), brain tumors (14.2 %), and postcranial surgery (13.3 %). Overall shunt failure at a mean follow-up of 11 months was 23 % with the median time to first shunt failure being 68 days. Shunt survival was worse in patients with meningitis (p=0.024), aqueductal stenosis (p=0.008), postcranial surgery hydrocephalus (p=0.006), Caesarean mode of delivery (p=0.036), congenital abnormalities (p= 0.031), and a past history of surgical excision of mass lesion (p=0.044).Frequency of shunt failure was also significantly affected by the location of brain tumor (p=0.015) and prematurity (p=0.015). Conclusion Premature infants still have a higher rate of shunt failure. Patients with meningitis, aqueductal stenosis, postcranial surgery hydrocephalus, congenital abnormalities, and a past history of surgical excision of mass lesion may have early shunt failure. However, the frequency of shunt failure that we observed (23 %) was much lower than that quoted earlier in the literature and this may be a consequence of rigorous periodic evaluation of patients with VP shunt in situ.
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.
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.
Late pediatric ventriculoperitoneal shunt failures: a Singapore tertiary institution's experience
Neurosurgical Focus, 2016
OBJECTIVE The introduction of ventriculoperitoneal shunts changed the way hydrocephalus was treated. Whereas much is known about the causes of shunt failure in the first few years, there is a paucity of data in the literature regarding the cause of late shunt failures. The authors conducted a study to find out the different causes of late shunt failures in their institution. METHODS A 10-year retrospective study of all the patients who were treated in the authors' hospital between 2006 and 2015 was conducted. Late shunt failures included those in patients who had to undergo shunt revision more than 5 years after their initial shunt insertion. The patient's notes and scans were reviewed to obtain the age and sex of the patient, the time it took for the shunt to fail, the reason for failure, and the patient's follow-up. RESULTS Forty-six patients in the authors' institution experienced 48 late shunt failures in the last 10 years. Their ages ranged from 7 to 26 years (1...
Egyptian Journal of Neurosurgery
Background Ventriculoperitoneal shunt is one of the most popular cerebrospinal fluid diversion procedures worldwide. Complications are common, but uncommon complications are rarely reported in the literature making a standardized guideline on management of unusual complications unavailable. We report this series of uncommon complications managed in our centre to share our experience and contribute to the pool of literature on the management of these weird complications of ventriculoperitoneal shunting. Case presentation The first case was a 10-year-old girl who presented with headache, early morning vomiting and itching over the tract of the shunt in the neck. She has had ventriculoperitoneal shunt and excision and repair of encephalocele at the age of 3 months in our facility. On physical examination, she was conscious with a Glasgow coma score of 15, and shunt valve was hardened. She had removal of the shunt with intraoperative finding of calcified shunt tubing and the valve, and ...
Factors affecting ventriculoperitoneal shunt survival in adult patients
Surgical Neurology International, 2015
Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting. Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan-Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox-Mantel) tests were used to determine the factors affecting shunt survival. Results: A total of 227 patients aged 18-85 years (mean: 45.8 years) were included in the study. The top four etiologies of hydrocephalus included post-cranial surgery (23.3%), brain tumor or cyst (22.9%), normal pressure hydrocephalus (15%), and intracranial hemorrhage (13.7%). The overall incidence of shunt malfunction was 15.4% with the median time to first shunt failure being 120 days. Etiology of hydrocephalus (P = 0.030) had a significant association with the development of shunt malfunction. Early shunt failure was associated with age (P < 0.001), duration of hospital stay (P < 0.001), Glasgow Coma Scale (GCS) score less than 13 (P = 0.010), excision of brain tumors (P = 0.008), and placement of extra-ventricular drains (P = 0.033). Conclusions: Patients with increased age, prolonged hospital stay, GCS score of less than 13, extra-ventricular drains in situ, or excision of brain tumors were more likely to experience early shunt malfunction.