Abdominal Pseudocysts Complicating CSF Shunting in Infants and Children

Abstract

Abdominal pseudocysts (APC) are rare complications of ventriculoperitoneal shunting for hydrocephalus. The authors studied retrospectively a series of 18 pediatric patients with APC. Signs and symptoms of shunt dysfunction were observed in 15 (83.3%), abdominal complaints in 10 (55.5%) and fever in 6 (33.3%). Prior to the diagnosis of APC, 2 patients suffered exploratory laparotomies due to important abdominal signs and symptoms. Ultrasonography was diagnostic in all cases and proved to be the method of choice in the evaluation of APC. Our series suggest that APC are strongly related to hardware infection and in some cases can result from a previous shunt infection not completely cured. The bacteriological examination of the tip of the peritoneal catheter was a reliable indicator of infection. According to our data, the best treatment seems to be the removal of the shunt system and the insertion of an external ventricular drainage. In our experience, almost half of the patients had a ventriculoatrial shunt replacing the peritoneal shunt at the end of the treatment.

Safe surgical approach to extrahepatic pseudocyst, a rare shunt complication: 2 case reports

“…In literature, it is seen that laparoscopy procedures are favored in the recent years [10]. In the presence of an infection, it is suggested that implanting an external ventricular drain and installing a new shunt after appropriate antibiotherapy and seeing CSF is sterile [2,4,8]. In our cases we saw that, sending the catheter to a different quadrant, without excision of the pseudocysts, is sufficient.…”

“…It is characterized with a cystic mass encircled with a fibrous wall with CSF and the shunt catheter inside [4]. One of the theories about the abdominal pseudocyst etiology is the inflammation theory, which proposes the main reason as recurrent infections, shunt revisions, intestinal adhesions and peritonitis [5].…”

“…Main pathologies in differential diagnosis with abdominal pseudocysts are mesenteric or omental cysts, duplication cysts, Iymphocele, cystic teratoma, cystic lymphangioma, pancreatic pseudocyts, abscess and bilomas. It is suggested that abdominal USG and radiography are sufficient for diagnosis, but to determine the exact location, size of the cyst, and the location of the shunt catheter; also to exclude other acute abdominal syndrome reasons, abdominal CT is reported as more valuable [2,4,6,8]. Typically, on extrahepatic pseudocyst cases, CT scan reveals a parenchyma free capsule formation with smooth margin extending out from the liver and isodense cyst content with CSF [6,8,9].…”

Intraabdominal Pressure: Is it a Cause of Shunt Dysfunction? A Pediatric Case Report

“…When literature was investigated, abdominal complications are; distal catheter migration and visceral perforation and/or extrusion (1,3,5,6, 11, 12, 14, 15, 17-21, 23, 24, 29-31), ascitis (2,13], and peritoneal pseudocysts (10,26). However when this literature was analyzedin detail nearly all of them are related with "non-functional" abdominal complications.…”

Laparoscopic assisted ventriculoperitoneal shunt revisions as an option for pediatric patients with previous intraabdominal complications

“…Several studies demonstrated that more than 44% of the patients with distal VPS complications had multiple abdominal revisions due to APC or peritonitis and end up as VAS candidates 3,11,21 .…”