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Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases
1Division of Pediatric Neurosurgery, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, M.S. Fiocruz, Rio de Janeiro, Brazil. fsalomao@ism.com.br
Insights
Abdominal pseudocysts (APC) are rare complications of ventriculoperitoneal shunting. Ultrasonography is the best diagnostic tool, and APC is often linked to shunt hardware infection. Treatment involves removing the shunt and using external ventricular drainage.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Medical Imaging
Background:
- Abdominal pseudocysts (APC) are uncommon complications following ventriculoperitoneal (VP) shunting for hydrocephalus.
- These pseudocysts can mimic other abdominal pathologies, leading to diagnostic challenges and invasive procedures.
Purpose of the Study:
- To retrospectively analyze the clinical presentation, diagnosis, and management of APC in pediatric patients.
- To investigate the association between APC, shunt hardware infection, and treatment outcomes.
Main Methods:
- Retrospective review of 18 pediatric patients diagnosed with APC after VP shunting.
- Evaluation of clinical signs, symptoms, diagnostic imaging (primarily ultrasonography), and bacteriological findings.
- Analysis of treatment strategies, including shunt removal, external ventricular drainage, and shunt revision.
Main Results:
- APC occurred in 18 pediatric patients, with 83.3% exhibiting signs of shunt dysfunction.
- Ultrasonography was highly effective (100% diagnostic accuracy) for identifying APC.
- A strong correlation was found between APC and shunt hardware infection, with positive bacterial cultures from catheter tips in infected cases.
- Exploratory laparotomies were performed in 2 patients prior to APC diagnosis.
- Treatment with shunt removal and external ventricular drainage was effective, with nearly half of patients later receiving a ventriculoatrial shunt.
Conclusions:
- Abdominal pseudocysts are a significant complication of VP shunting, often associated with underlying shunt infection.
- Ultrasonography is the preferred diagnostic modality for APC.
- Management should focus on addressing the infection, often necessitating shunt system removal and temporary external drainage, followed by shunt revision.
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.