Peritoneal complications of ventriculo-peritoneal shunt: retrospective review of 23 cases

ABSTRACT

The management of hydrocephalus most commonly involves placement of ventriculoperitoneal shunts. However, high rates of complications have been reported, ranging from 24-47%, among which abdominal complications account for approximately 25%. The aims were evaluation of symptoms, diagnosis and surgical treatment in abdominal complications following ventriculoperitoneal shunt. Between June 2007 and August 2010 a retrospective review of 23 patients suffering from late complications of ventriculoperitoneal shunt were done at Al-Kadhimyia teaching hospital, Baghdad, Iraq. Patient presenting symptoms, time between the insetion of ventriculoperitoneal shunt, onset of abdominal complications and the operative time were recorded. Methods of diagnosis were also recorded. There were 4 male and 19 females, FM ratio 4-751 and mean age of 11.5 years. Methods of diagnosis were as follows abdominal CT in 10 patients, abdominal Ultrasound in 8 patients and x-ray in remaining 5 patients. Clinical presentations fever in 26.1%, abdominal distension in 26.1%, abdominal pain in 21.7%, nusea and vomiting in 13% and headache in 13%. Abdominal complications include infections [abscesses and peritonitis] in 26.1%, shunt disconnection with intraperitoneal distal catheter migration 21.7%, coiled catheters in the subcutaneous tissue in 21.7%, pseudocysts 17.4%, CSF ascites 8.7%, and excessive length of intraperitoenal tube 4.3%. Surgical treatment was extraction of the foreign body in shunt disconnection with intraperitoneal distal catheter migration, evacuation, debridement, lavage and drainage for pseudocysts, abscess and peritonitis, shortening of the intraperitoneal tube in excessive length. The operative time ranged from 45-150 minutes. Shunts replacement or revision was ultimately successful in all patients. Infection is the most common abdominal complication after ventriculoperitoneal shunt. Infected shunt should be removed and replaced when all signs of infection subside. Reimplantation is successful in patients with CSF pseudocyst and ascitis