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The sonographic signs of the peritoneal pseudocyst obstructing the ventriculo-peritoneal shunt in children
M Grunebaum1, N Ziv, L Kornreich
1Department of Pediatric Radiology, Beilinson Medical Center, Petah Tiqva, Israel.
Insights
Ventriculo-peritoneal shunt (VPS) obstruction in children is common. Ultrasound effectively diagnoses peritoneal pseudocysts or abscesses causing VPS blockage, including rare cases like parasitic obstruction.
Area of Science:
- Pediatric Neurosurgery
- Medical Imaging
- Infectious Diseases
Background:
- Ventriculo-peritoneal shunts (VPS) are increasingly used to treat pediatric hydrocephalus.
- Shunt obstruction is a primary cause of neurological deterioration in these patients.
Observation:
- Distal VPS obstruction in the peritoneal cavity can manifest as pseudocysts, infected pseudocysts, or abscesses.
- Abdominal radiography and ultrasonography are key diagnostic tools for these complications.
Findings:
- Sonographic signs of peritoneal pathologies causing VPS obstruction are described.
- Differential diagnosis is discussed with six case examples.
- A unique case involved Ascaris lumbricoides obstructing a VPS within an abscess.
Implications:
- Accurate diagnosis of VPS obstruction is crucial for timely intervention.
- Ultrasonography plays a vital role in identifying diverse causes of shunt failure.
- Awareness of rare etiologies, such as parasitic involvement, is important for pediatric neurosurgeons.
Abstract:
The installation of the ventriculo-peritoneal shunt (VPS) is on the rise in the pediatric age. Its obstruction is a major cause for further deterioration of the already present hydrocephalus. Distal VPS obstruction may be due to a pseudocyst, an infected pseudocyst or an abscess-formation within the peritoneal cavity. These pathologies are identified through an abdominal radiograph and ultrasonography. The sonographic signs are described and its differential diagnosis is discussed in relation to 6 diagnosed cases. One VPS was obstructed by Ascaris lumbricoides clinging to its tip within an abscess.