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Fatani GM, Bustangi NM, Kamal JS, Sabbagh AJ. Ventriculoperitoneal shunt-associated abdominal cerebrospinal fluid pseudocysts and the role of laparoscopy and a proposed management algorithm in its treatment. A report of 2 cases. ACTA ACUST UNITED AC 2021; 25:320-326. [PMID: 33130815 PMCID: PMC8015616 DOI: 10.17712/nsj.2020.4.20200053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abdominal cerebrospinal fluid pseudocyst (APC) is a rare complication associated with a ventriculoperitoneal shunt (VPS) placement. Abdominal cerebrospinal fluid pseudocyst is defined as a cyst surrounded by a non-epithelial lining and filled with the cerebrospinal fluid (CSF). In general, 1% - 4.5% of all patients treated with a VPS develop CSF pseudocysts. Here, we have presented 2 cases of APC complicating VPS placement and a proposed treatment management algorithm. The cases pertained to 7-year-old and 5-year-old children who had undergone VPS placement during infancy and presented with progressive abdominal distention and vomiting and fever, respectively. Both cases were assessed using similar investigations and imaging modalities and diagnosed with APC. However, the treatments were individually tailored based on the algorithm; successful outcomes were achieved in both patients. Abdominal cerebrospinal fluid pseudocyst treatment is difficult considering the presence of adhesions and infection and is associated with a high recurrence rate.
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Affiliation(s)
- Ghaida M Fatani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail:
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Koide Y, Osako T, Kameda M, Ihoriya H, Yamamoto H, Fujisaki N, Aokage T, Yumoto T, Date I, Naito H, Nakao A. Huge abdominal cerebrospinal fluid pseudocyst following ventriculoperitoneal shunt: a case report. J Med Case Rep 2019; 13:361. [PMID: 31818327 PMCID: PMC6902322 DOI: 10.1186/s13256-019-2308-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 10/29/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Abdominal pseudocysts comprising cerebrospinal fluid are an uncommon but significant complication in patients with ventriculoperitoneal shunt. We present a successfully treated 12-year-old boy with a history of ventriculoperitoneal shunting and a huge abdominal cerebrospinal fluid pseudocyst. Case presentation A12-year-old Japanese boy presented with a deteriorated consciousness and a palpable and elastic large lower abdominal mass. Computed tomography of his abdomen demonstrated a collection of homogenous low-density fluid near the catheter tip of the ventriculoperitoneal shunt. Cerebral computed tomography revealed an increased ventricular size. Based on the clinical diagnosis of abdominal pseudocyst, the peritoneal shunt catheter was secured and divided into two parts by cutting it on the chest; then, the proximal side of the peritoneal shunt catheter was externalized for extraventricular drainage. The cyst was percutaneously aspirated with ultrasound guidance, and the distal side of the peritoneal shunt catheter was removed. The distal side of the peritoneal shunt catheter was reinserted in another position into his abdomen after 3-week extraventricular drainage management. Conclusion Emergency physicians should know about this potential complication as an important differential diagnosis resulting from acute abdominal complaints in patients with ventriculoperitoneal shunts.
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Affiliation(s)
- Yasuhiro Koide
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.,Center for Graduate Medical Education, Okayama University Hospital, Okayama, Japan
| | - Takaaki Osako
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromi Ihoriya
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirotsugu Yamamoto
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Noritomo Fujisaki
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiyuki Aokage
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
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Satyarthee GD. Commentary. J Neurosci Rural Pract 2019; 10:166-167. [PMID: 30765999 PMCID: PMC6337982 DOI: 10.4103/jnrp.jnrp_262_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Dzongowski E, Coriolano K, de Ribaupierre S, Jones SA. Treatment of abdominal pseudocysts and associated ventricuoperitoneal shunt failure. Childs Nerv Syst 2017; 33:2087-2093. [PMID: 28993858 DOI: 10.1007/s00381-017-3609-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/04/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to determine whether drainage and revision are an effective treatment for abdominal pseudocyst associated ventriculoperitoneal (VP) shunt failure by estimating the total rate of secondary shunt failure. METHODS We performed a retrospective review of children with hydrocephalus diagnosed with and treated for an abdominal pseudocyst at the Children's Hospital, London Health Sciences Centre (LHSC) between January 1, 2000 and May 31, 2016 (ethics approval # 108136). Patients with a VP shunt were included if (i) the development of an abdominal pseudocyst at age 2 to 18 years was identified, (ii) treatment of the pseudocyst by either interventional radiology (IR) or surgical drainage, and (iii) revision of the VP shunt. Demographic data and details of pseudocyst formation/ treatment as well as subsequent failures were identified. RESULTS Twelve patients who had a VP shunt developed abdominal pseudocyst and met inclusion criteria. A 91% shunt failure rate after drainage and shunt revision was identified. Three patients had the pseudocyst drained in interventional radiology and then externalized due to shunt infection. Nine patients were treated by surgical revision. Ten patients experienced recurrent shunt failure following initial drainage of the pseudocyst: pseudocyst reoccurrence (n = 3), distal obstruction from adhesions (n = 1), and uncleared infection (n = 6). CONCLUSION The results suggest that pseudocyst drainage and shunt revision is ineffective in providing long-term resolution of shunt problems.
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Affiliation(s)
- Emily Dzongowski
- Division of Paediatric Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Kamary Coriolano
- Department of Paediatrics, Western University, London, ON, Canada
| | - Sandrine de Ribaupierre
- Division of Paediatric Surgery, Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Sarah A Jones
- Division of Paediatric Surgery, Department of Surgery, Western University, London, ON, Canada.
- Paediatric Surgery, Room B1-131, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6C 2V3, Canada.
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Masoudi MS, Rasafian M, Naghmehsanj Z, Ghaffarpasand F. Intraperitoneal cerebrospinal fluid pseudocyst with ventriculoperitoneal shunt. Afr J Paediatr Surg 2017; 14:56-58. [PMID: 29557353 PMCID: PMC5881288 DOI: 10.4103/ajps.ajps_94_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ventriculoperitoneal (VP) shunting is mostly used in the treatment of hydrocephalus and many complications have been reported with this method. Abdominal Pseudocyst (APC) are relatively uncommon but important complications in patients with VP shunts. We herein report the case of a 9-year-old boy with VP shunt who presented with abdominal distension, abdominal pain, malaise, and decrease of appetite. Abdominal pelvic computed tomography confirmed a diagnosis of APC. Laparotomy was done and VP shunt was placed into the other side of peritoneal cavity again. Also here, etiology, presentation, diagnosis, and treatment of APC were reviewed.
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Affiliation(s)
| | - Marziye Rasafian
- Department of Neurosurgery, AJA University of Medical Sciences, Tehran, Iran
| | - Zahra Naghmehsanj
- Department of Neurosurgery, AJA University of Medical Sciences, Tehran, Iran
| | - Fariborz Ghaffarpasand
- Department of Neurosurgery, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Rinker EK, Williams TR, Myers DT. CSF shunt complications: what the abdominal imager needs to know. ACTA ACUST UNITED AC 2015; 40:2030-40. [DOI: 10.1007/s00261-015-0366-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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