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[Abdominal complications of ventriculo-peritoneal shunts in children. 65 cases]
Insights
Abdominal complications occurred in 65 of 1200 children treated for hydrocephalus with a ventriculo-peritoneal shunt. Bacterial contamination leading to peritonitis and catheter migration are the most frequent and severe complications.
Area of Science:
- Neurosurgery
- Pediatric Surgery
- Medical Device Complications
Context:
- Hydrocephalus management in children often involves ventriculo-peritoneal (VP) shunts.
- VP shunts are implanted to divert cerebrospinal fluid (CSF) and reduce intracranial pressure.
- Long-term complications can arise from indwelling shunt systems.
Purpose:
- To analyze the incidence and types of abdominal complications following VP shunt placement in pediatric hydrocephalus patients.
- To identify risk factors and etiological causes of these complications.
- To evaluate treatment strategies for VP shunt-related abdominal issues.
Summary:
- A review of 1200 pediatric hydrocephalus cases treated with VP shunts between 1971 and 1982 identified 65 instances of abdominal complications.
- While rare complications like viscus perforation and intestinal obstruction occurred, peritonitis without perforation (32 cases) and catheter migration into the colon (19 cases) were most common.
- These primary complications are attributed to intra-operative bacterial contamination and manifest weeks to months post-surgery.
- Complications were associated with 8 of 9 deaths, primarily due to gram-negative meningitis.
Impact:
- Highlights the significant risk of abdominal complications associated with pediatric VP shunts.
- Emphasizes the critical role of sterile surgical technique to prevent bacterial contamination.
- Informs clinical practice regarding early diagnosis and management of shunt-related abdominal issues.
- Underscores the potentially fatal consequences of shunt infections, necessitating prompt intervention.
Abstract:
From 1971 to 1982, among 1 200 children with hydrocephalus cured by ventriculo-peritoneal shunt, 65 have presented an abdominal complication. Some of them are rare and easily explainable: 2 intra-operative viscus perforations, 1 intestinal obstruction, 3 extrusions of the catheter into an inguinal hernia. Also rare, C.S.F. ascites (5 cases) et C.S.F. pseudocysts (3 cases) presented with typical symptomatology easily diagnosed, but their etiology is not clear. The main complications are peritonitis without perforation (32 cases) and migrations of the catheter in the colon (19 cases): their etiology is an intra-operative bacterial contamination, they happen during the following weeks or months after the shunt procedure. They are associated with 8 among 9 deaths of our data by gram negative germ meningitis. Removal of the peritoneal catheter and temporary external shunt are their main treatment.