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PubMedDate not supplied

Ascites complicating ventriculoperitoneal shunts.

Ventriculoperitoneal shunts are currently a standard therapy for obstructive hydrocephalus. These shunts are associated with a variety of abdominal complications, one of which is the development of ascites. We report an 11-year-old girl with a ventriculoperitoneal shunt in whom a low-grade peritoneal infection presented with ascites. This case demonstrates the importance of diagnostic paracenteses, appropriate antibiotic therapy and the potential need to establish an alternative route for cerebrospinal fluid diversion in patients with ventriculoperitoneal shunts and ascites.

Ascites↗
PubMed1977

Simulated testicular torsion in a neonate: complication of ventriculoperitoneal shunt.

Ventriculoperitoneal shunts are a common form of cerebrospinal fluid diversion in treating hydrocephalus. With their use various complications have been noted. Herein is described a shunt complication which simulated an acute scrotal condition. The operative findings and treatment are discussed. A brief review of the literature is also given.

Acute Disease↗
PubMed2004

Laparoscopic revision of a ventriculoperitoneal shunt.

Ventriculoperitoneal (VP) shunts are the most common treatment modality for hydrocephalus. Distal catheter malfunction represents a surgical emergency and a significant cause of procedural morbidity. We report the case of a patient with acute abdominal pain following VP shunt insertion. On examination she had a tender, irreducible bulge at the abdominal laparotomy site. Exploratory laparoscopy of the abdomen yielded no abdominal wall abnormalities. At the same time, the distal catheter was noted to be absent. The abdominal bulge was incised along the laparotomy scar and clear cerebrospinal fluid was encountered. The incision was explored and the distal catheter was coiled and knotted within the preperitoneal space. The catheter was laparoscopically returned to the peritoneal cavity. This case exemplifies the utility of laparoscopy for VP shunt revision and we present a review of laparoscopic shunt revision.

Embolization, Therapeutic↗
PubMed2006

Spontaneous umbilical CSF fistula in an adult as a complication of a ventriculoperitoneal shunt.

Ventriculoperitoneal (VP) shunt is the most commonly used CSF shunt in the modern era and widely accepted for the management of hydrocephalus. Numerous abdominal complications have been reported in the literature. Spontaneous umbilical fistula from VP shunt, although uncommon, has been reported previously in children, but never in an adult. This is a case report on an adult who was treated for spontaneous umbilical fistula at our unit.

Adolescent↗
PubMed1992

The risk of abdominal operations in children with ventriculoperitoneal shunts.

Ventriculoperitoneal (VP) shunts are the operations of choice for patients with hydrocephalus in most pediatric hospitals. Children with VP shunts frequently undergo abdominal operations unrelated to their shunts, which might lead to shunt infections or to malfunctions related to adhesions. Although prophylactic antibiotics are usually used in this setting, there are few data to support their use, or to assess other risks to the shunt from the abdominal procedures. Consequently, we reviewed the records of 37 children with VP shunts who underwent a total of 44 abdominal operations. In 8 cases, the genitourinary (GU) tract was opened (ureteral reimplantation, bladder augmentation, nephrectomy), whereas in 18 patients the gastrointestinal (GI) tract was opened (appendectomy, gastrostomy, small/large bowel resection). In 18 operations neither GI nor GU tract was opened (lysis of adhesions, herniorrhaphy, orchiopexy). Antibiotic coverage was highly variable: 9 received no antibiotics, 9 received antibiotics only postoperatively, 4 were given antibiotics only preoperatively, and in 22 cases antibiotics were given both preoperatively and postoperatively. One shunt that was involved in a periappendiceal abscess was exteriorized and later successfully replaced. In the remaining cases, no episodes of shunt infection or malfunction occurred in 1 to 10 years of follow-up. Likewise, no abdominal cerebrospinal fluid pseudocysts formed as a result of abdominal adhesions. These data demonstrate that children with VP shunts can safely undergo abdominal operations, even when the GI or GU systems are opened, with minimal risk of shunt infection or malfunction. Rigid protocols of prophylactic antibiotics cannot be supported by this series.

Abdomen↗
PubMed1983

Scrotal migration of ventriculoperitoneal shunts.

Ventriculoperitoneal diversion of cerebrospinal fluid in infants and children with hydrocephalus has become the procedure of choice over the last 15 years. It has replaced ventriculoatrial shunts, resulting in a marked decrease in the complication rate after such procedures. Four cases of migration of the shunt tip through patent processus vaginalis resulting in scrotal hydrocele are presented.

Cerebrospinal Fluid Shunts↗
PubMed2006

Umbilical perforation: an unusual complication of a ventriculoperitoneal shunt.

INTRODUCTION: Ventriculoperitoneal shunt operations are the most common pediatric neurosurgical procedures in the treatment of hydrocephalus. However, ventricular shunting is frequently associated with a wide variety of complications. Umbilical perforation is an extremely rare complication of ventriculoperitoneal shunts. CASE REPORT: We present an infant with umbilical abscess, meningitis, and umbilical perforation of the distal end of the ventriculoperitoneal shunt, which was placed for congenital hydrocephalus.

Abscess↗
PubMed1985

Primary intracranial germinoma with massive ventriculoperitoneal shunt metastases.

Ventriculoperitoneal shunt metastases from primary intracranial germinomas are extremely rare. To date, only three case reports of this phenomenon have appeared in the literature. We present the case of a 25-year-old black male who developed ventriculoperitoneal shunt metastases 10 months following diagnosis of an intracranial germinoma. Radiotherapy destroyed most of the intracranial tumor, but abdominal metastases became progressive and were not treated with radiotherapy. The role of radiotherapy in the treatment of ventriculoperitoneal shunt metastases is examined and previous cases in the literature are reviewed.

Abdominal Neoplasms↗
PubMed2005

[Splenic trauma by ventriculoperitoneal shunt catheter].

Ventriculoperitoneal shunt is used as a treatment of hydrocephalus. Although this procedure is usually safe, several abdominal complications have been reported in the literature. However, to our knowledge, a catheter-induced splenic trauma has not been previously described. We report here the case of a patient who presented with a spontaneous splenic trauma, 10 years after ventriculoperitoneal shunt insertion. A conservative treatment with careful monitoring was successful and the patient recovered without surgery.

Adult↗
PubMed2004

A thoracic complication of ventriculoperitoneal shunt: symptomatic hydrothorax from intrathoracic migration of a ventriculoperitoneal shunt catheter.

Thoracic complications of ventriculoperitoneal (VP) shunt are very rare. We report an unusual case of VP shunt intrathoracic migration, associated with symptomatic hydrothorax. The patient was successfully managed with revision. We reviewed the 10 cases reported in the literature and discussed the mechanism of shunt-tip migration.

Catheters, Indwelling↗
PubMed1981

Intratumoral hemorrhage after a ventriculoperitoneal shunting procedure.

Ventriculoperitoneal shunting has been accepted as a safe and useful preliminary procedure that lowers the mortality and morbidity of definitive surgery for tumors causing obstructive hydrocephalus. We are reporting four patients with intratumoral hemorrhage as a complication of shunting. The hemorrhage was massive and fatal in two patients, one with an unverified pineal tumor and the other with a malignant astrocytoma of the thalamus. The hemorrhage was small and limited in the other two patients, one with a glioblastoma of the thalamus and the other with a cerebellar astrocytoma. On the basis of this experience, we conclude that the possibility of intratumoral hemorrhage should be taken into consideration when planning the preoperative management of obstructive hydrocephalus caused by brain tumors. It is possible that ventricular decompression may result in rapid motion and distortion of the intracranial structures and a sudden imbalance between intracranial and intratumoral pressures, leading to vascular insufficiency, congestion, and then hemorrhage within the tumor.

Adolescent↗
PubMed2000

Minilaparoscopically assisted placement of ventriculoperitoneal shunts.

BACKGROUND: Ventriculoperitoneal (VP) shunting remains the preferred treatment for hydrocephalus. Laparoscopic techniques to aid in the placement of the peritoneal portion of the catheter have been reported previously. We describe a minilaparoscopic VP shunt (MLVPS) insertion technique that facilitates directed placement of the peritoneal portion of the catheter in most patients, including those with obese abdomens previously subjected to surgery. In this study we review our experience with MLVPS placement. METHODS: All cases of MLVPS insertions at the University of Kentucky Medical Center and Lexington VA Hospital performed between February 1998 and March 1999 were reviewed retrospectively. A total of 27 patients (13 males and 14 females) ranging in age from 4 to 81 years (mean, 41 years) underwent VP shunting. The MLVPS insertion was performed via a 2-mm laparoscope and a separate 2-mm incision for catheter insertion using a venous introducer kit. In patients who had prior abdominal surgery, a 5-mm direct-view trocar was used. RESULTS: The MLVPS procedure was successful in 27 patients (100%). The mean number of prior shunts was 2 (range, 0-28). Of the 27 patients, 16 (59%) had undergone previous abdominal surgery. The mean operative time was 76 min (range, 19-155 min). There were no intra- or postoperative complications, and no mortalities. The follow-up period extended from 1 to 12 months. CONCLUSIONS: Findings show MLVPS placement to be safe and feasible. It allows accurate, directed placement of the VP shunt with a 2-mm laparoscope and a second 2-mm incision for shunt insertion. The procedure is associated with reduced trauma to the abdominal wall and minimal postoperative ileus. Long-term follow-up assessment of shunt function is planned.

Adolescent↗
PubMed2001

Laparoscopic management of abdominal complications in ventriculoperitoneal shunt surgery.

Ventriculoperitoneal (VP) shunts are among the most frequently performed operations in the management of hydrocephalus. Abdominal complications, though rare, are reported to occur in 5-47%. VP shunt obstruction or malfunction leads to raised intracranial pressure, which requires immediate intervention. Recently we have used the laparoscope to manage abdominal complications of VP shunt in two patients. The first patient had hydrocephalus secondary to tubercular meningitis. She developed recurrent intraabdominal cerebrospinal fluid (CSF) pseudocysts, possibly due to subtle peritoneal infection. In the second patient, who developed hydrocephalus following subarachnoid haemorrhage, the lower end of the shunt was malfunctioning due to retraction into the extraperitoneal tissues. The distal end of the VP shunt was revised in both patients with the help of a laparoscopically assisted technique. Thus, a conventional laparotomy, along with its various associated postoperative problems, was avoided without compromising the quality of surgery.

Abdomen↗
PubMedDate not supplied

Laparoscopic guidance or revision of ventriculoperitoneal shunts in children.

BACKGROUND: Ventriculoperitoneal shunt is the preferred treatment for hydrocephalus. Known complications include infection, obstruction, and disconnection with the fractured fragment migrating in the peritoneal cavity. We report 17 cases of laparoscopic evaluation and revision of ventriculoperitoneal shunts in children. METHODS: From January 2000 through October 2002, we retrospectively reviewed our experience with laparoscopy and ventriculoperitoneal shunts. RESULTS: Laparoscopy was performed in 17 children with a malfunctioning shunt, presumed shunt dislodgment or disconnection, reinsertion of a shunt after externalization, and primary shunt placement. Six patients (35%) were converted to an open laparotomy due to dense adhesions. Eleven patients (65%) underwent successful laparoscopic-assisted ventriculoperitoneal shunt placement: 5/11 (45%) had lysis of adhesions or pseudocyst marsupialization with repositioning of a functional shunt, or both; 3/11 (27%) had successful retrieval of a disconnected catheter with reinsertion of a new catheter; 2/11 (18%) had laparoscopic confirmation of satisfactory placement and function, requiring no revision; 1/11 (9%) had an initial shunt placed with laparoscopic guidance due to the obesity. Operative time for the laparoscopic procedure ranged from 30 minutes to 60 minutes. All laparoscopic procedures used 1-mm or two 5-mm ports. Perioperatively, no adverse neurological sequelae occurred due to the pneumoperitoneum. CONCLUSIONS: Laparoscopic guidance or revision of ventriculoperitoneal shunts permits (1) direct visualization of catheter insertion within the peritoneal cavity, (2) satisfactory positioning, (3) lysis of adhesions or marsupialization with catheter repositioning, or both, and (4) retrieval of fractured catheters.

Adolescent↗
PubMed1991

Abdominal cerebrospinal fluid pseudocyst: occurrence after intraperitoneal urological surgery in children with ventriculoperitoneal shunts.

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.

Abdomen↗
PubMed2000

Laparoscopic surgery in children with ventriculoperitoneal shunts.

BACKGROUND/PURPOSE: Children with ventriculoperitoneal shunts may require laparoscopic surgery. The authors aimed to determine if this group of children are at greater risk for complications or technical problems. METHODS: Children with ventriculoperitoneal shunts who underwent laparoscopic surgery between 1995 and 1998 were reviewed. In addition, the subset of children undergoing laparoscopic fundoplication were compared with the group of children without shunts who- had the same operation during the same period. RESULTS: Ten children with ventriculoperitoneal shunts underwent laparoscopic surgery. Three had complications, none of which were caused by the shunt. None had any evidence of shunt dysfunction related to the laparoscopic procedure. The 6 children with shunts who underwent laparoscopic fundoplication were compared with 17 similar children without shunts who underwent the same operation during the same period. There were no differences between the groups with respect to operating time, conversion to an open approach, or complications. CONCLUSION: Laparoscopic surgery can be performed safely and effectively in children with ventriculoperitoneal shunts.

Adolescent↗