Abdominal pseudocyst (APC) is an uncommon complication of ventriculoperitoneal shunts. Various predisposing factors have been attributed to it, including the presence of infection and multiple shunt revisions. We reviewed the records of shunt revisions performed over a 20-year period. During that time, 64 cases of APC were found in 36 patients. The records were then reviewed for the presence of infection, history of necrotizing enterocolitis, prior abdominal surgery, and treatment performed. Of the cases of APC, 46 were primary and 18 were recurrent. A history of prior abdominal surgery other than shunt revision was found in 47% of patients and a history of necrotizing enterocolitis was found in 19% of patients. The average number of prior shunt revisions was 4.1 per patient. Shunt infection as defined by positive cultures of either cerebrospinal fluid or abdominal fluid was present in only 23% of cases of APC. A history of prior shunt infection was present in 30% of patients. Infection was treated by shunt removal, external ventricular drainage, and appropriate antibiotics. After the infection was cleared or if no infection was present, treatment consisted of: (1) repositioning the distal catheter into the peritoneum, (2) repositioning the distal catheter into the pleural space, the atrium, or the gallbladder, (3) exploratory laparotomy with lysis of adhesions and repositioning the peritoneal catheter, (4) APC aspiration only, or (5) shunt removal or disconnection. Because of the complexity of APC management, we analyzed the outcomes of our cases and outlined an algorithm to simplify this process.
Group 1 patients usually had a normal head size at birth, they rarely required shunt placement, their head growth eventually leveled off toward the 98th percentile line, and their outcomes were generally good. Although five of nine Group 2 patients required subdural punctures and/or SDP shunt placement, that group of patients also developed well. Infants with nontraumatic subdural hematomas or hygromas, presumably associated with benign extracerebral fluid collections, can often experience significant resolutions of the hematoma or hygroma within several months without surgical treatment.
Patients who underwent ACD or ACDF did well and benefited from their operations. Those who underwent ACDF did better than those who underwent ACD. Length of follow-up was also an important predictor of current levels of function and pain.
A retrospective study of fractures of peritoneal catheters of ventriculoperitoneal shunts is described. Fracture of the peritoneal catheter accounts for 21.2% of shunt revisions. During the time period of January 1985 through July 1993, 401 PS Medical peritoneal catheters were installed and 23 fractures occurred. The fracture rate of PS Medical small-sized catheters is 15.3%. The fracture rate of PS Medical regular-sized catheters is 2.1 %. The overall survival rates of the PS Medical small-sized and regular-sized catheters are significantly statistically different (p < 0.001). The peritoneal catheters fractured most frequently in the neck.
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