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Abdominal cerebrospinal fluid pseudocyst: occurrence after intraperitoneal urological surgery in children with
Insights
Children with ventriculoperitoneal shunts undergoing bowel surgery face increased risk of abdominal cerebrospinal fluid pseudocysts. Surgeons must be aware of this complication to ensure timely diagnosis and treatment.
Area of Science:
- Pediatric Surgery
- Neurosurgery
- Urology
Background:
- Ventriculoperitoneal shunts are common in children with myelomeningocele.
- Urinary tract reconstructive surgery using bowel is increasingly performed in these patients.
- Exposure of the shunt's peritoneal end during surgery increases infection and malfunction risks.
Observation:
- A retrospective review of 103 children with myelomeningocele and ventriculoperitoneal shunts was conducted.
- 27 patients underwent bowel-bladder reconstructive surgery.
- Abdominal cerebrospinal fluid pseudocysts were analyzed.
Findings:
- Pseudocyst formation occurred in 22% of patients with intra-abdominal surgery versus 1.3% without.
- 6 of 27 patients developed 8 pseudocysts, often presenting with abdominal pain or increased intracranial pressure.
- Pseudocyst walls were composed of matted bowel loops, requiring intervention including shunt revision in 5 patients.
Implications:
- Abdominal cerebrospinal fluid pseudocyst development is linked to prior abdominal surgery.
- Pediatric urological and general surgeons must recognize this complication in children with ventriculoperitoneal shunts.
- Awareness can lead to earlier detection and management, potentially preventing shunt malfunction and improving patient outcomes.
Abstract:
Increasingly, children with ventriculoperitoneal shunts are undergoing urinary tract reconstructive surgery with bowel. The peritoneal end of the ventriculoperitoneal shunt tubing usually is exposed during the procedure, making the system vulnerable to infections and malfunction. The records of 103 myelomeningocele children with ventriculoperitoneal shunts and bowel-bladder reconstructive surgical procedures (27) were reviewed for evidence of an abdominal cerebrospinal fluid pseudocyst (6). Pseudocyst formation occurred in only 1 of 76 ventriculoperitoneal shunt patients (1.3%) who had not undergone versus 6 of 27 (22%) who had undergone an intra-abdominal procedure. The 6 children had a total of 8 pseudocysts, including 7 pseudocysts that developed 8 days to 47 months (average 15.1 months) after the reconstructive surgery and 1 that developed before reconstructive surgery. All patients had abdominal symptoms (pain or mass) or symptoms of increased intracranial pressure. Treatment included computerized tomography-guided needle aspiration or abdominal exploration with cyst evacuation and shunt repositioning or replacement. The walls of the pseudocyst were formed by matted loops of bowel. Additional shunt surgery was required in 5 patients with conversion to ventriculoatrial shunts. We conclude that the development of an abdominal cerebrospinal fluid pseudocyst is at least in part related to the prior abdominal surgery. Thus, pediatric urological and general surgeons caring for children with ventriculoperitoneal shunts should be aware of this complication.