Abdominal complications in patients with a ventriculoperitoneal shunt: proposal for management recommendations from a single pediatric tertiary center

Márquez, Yamila Nadia Itati Basilotta; Mengide, Juan Pablo; Linares, Juan Manuel Dávila; Saenz, Amparo; Argañaraz, Romina; Mantese, Beatriz

doi:10.1007/s00381-021-05121-y

Cited by 4 publications

(5 citation statements)

References 31 publications

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“…In contrast, the abdominal part of a VP shunt can also be thoroughly evaluated with CT. [ 2 , 10 ]. Since almost all patients with VPS have free fluid collections in the pelvis, which happens in patients with advanced perforated appendicitis as well, difficulties typically develop owing to the detection of free fluid, septate fluid collections, or cyst-like structures in the abdomen in those patients [ 15 ]. However, free fluid or septate fluid collections are not always suggestive of an urgent abdominal issue because an abdominal pseudocyst (APC) could potentially be present.…”

Section: Discussionmentioning

confidence: 99%

“…Other mechanisms are connected to repeated surgical treatments. We recommend a laparotomy and/or percutaneous draining as cyst removal procedures because we believe that every APC is infectious, even though surgical evacuation may not always be necessary [ 3 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…The average length of the prescribed antibiotic course is 14 days, and it typically consists of the following antibiotics: amoxicillin/clavulanate, ampicillin/sulbactam, meropenem, piperacillin/tazobactam, and vancomycin [ 3 , 7 , 10 , 15 ] ( Table 3 ). However, the decision to prescribe an empiric antibiotic regimen should be determined on a case-by-case basis in accordance with local protocols and in consultation with a microbiologist or infectious diseases specialist because there is not enough data to do so otherwise [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Appendicitis and Peritonitis in Children with a Ventriculo-Peritoneal Shunt

et al. 2023

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The purpose of this study was to outline the management of patients with appendicitis and ventriculoperitoneal shunt (VPS) in the largest pediatric surgery department in Germany. Patients with VPS presenting with an acute abdomen between 2012 and 2022 at a tertiary-care pediatric facility were the subject of a retrospective descriptive analysis. Patients were divided into two groups based on their diagnoses: group A (appendicitis) and group B (primary peritonitis). Medical records were analyzed to look at the diagnostics, operative approach, complications, peritoneal and liquor culture, and antibiotic treatment. A total of seventeen patients were examined: seven patients in group A and ten individuals in group B. In the present study patients in group A typically presented younger, sicker, and with more neurological symptoms than those in group B. All patients with appendicitis had their VPS exteriorized, and a new shunt system into the peritoneum was reimplanted 20 days later. Surgery should be aggressively administered to patients who present with an acute abdomen and a VPS. Change of the whole shunt system is suggested. Shunt infection and dysfunction should be ruled out in patients with abdominal symptoms, and surgical care should be started with a low threshold.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Appendicitis and Peritonitis in Children with a Ventriculo-Peritoneal Shunt

et al. 2023

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“…It is well known that a high number of surgical revisions or pressure changes follows the implantation of a CSF-shunt [21][22][23]. But most of these studies only focused on causes like infections, dislocation or rupture of the shunt-catheter [24,25]. Dave et al shows that a third of shunt malfunctions in pediatric patients leads to those avoidable causes [26].…”

Section: Discussionmentioning

confidence: 99%

Valve pressure adjustments of cerebrospinal fluid shunts – longitudinal analysis of 614 patients

Schön

Krigers

Klingenschmid

et al. 2023

Preprint

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Background The implantation of a cerebrospinal fluid (CSF) shunt is one of the most common interventions in neurosurgery. However, there is a high rate of re-interventions e.g., surgical revisions, changes of valve pressure or radiological examinations. Various operating techniques, shunt valves and settings have been used in the past decades. Our goal was to investigate the clinical and technical characteristics influencing the need for intervention. Methods 614 patients between 2000 and 2019 which were treated surgically or seen as out-patients with a CSF-shunt dependent hydrocephalus at our department were longitudinally analyzed. Interventions were defined as any change in valve pressure setting or revision surgery. The clinical and technical data were retrospectively collected and analyzed using integrated regression and cox regression. Results 289 (47.1%) male and 325 (52.9%) female patients with a median age of 61 years (IqR: 47 – 70), with 441 (71.9%) ventriculoperitoneal shunts (VP) and 150 (24.4%) ventriculoatrial shunts, 351 (57.7%) programmable and 257 (42.3%) non-programmable shunts were documented. The median follow-up was 53.9 months (CI95%: 47.5 – 60.2, range: 0 – 463). Female patients were looked after significantly longer (60.0 months, CI95% 50.9 - 69.1). The average time until the first intervention was 98 months (IqR: 81.8 – 115.2). Gender, height, weight and BMI did not influence the need for earlier intervention. In long-term follow-up, valve pressure which never needed an intervention was influenced by the type of the shunt (VA or VP) and the programmability of the valve. Gender, height, weight and BMI had no impact on the pressure setting. Conclusion The individual pressure setting with none to fewer interventions is influenced by the programmability of the CSF-shunt, the age of the patient and the shunt-type. Gender, height, weight and BMI are not clinically relevant to identify the ideal valve pressure.

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“…We conclude that conventional X‑rays—although routinely used to confirm or exclude VP shunt continuity—may provide important clues with regard to the etiology of VP shunt dysfunction [ 1 , 2 ].…”

Section: Case Reportmentioning

confidence: 99%

Distended abdomen due to a pseudocyst around a ventriculoperitoneal shunt

Meyer

Nemat

Linsler

et al. 2021

Wien Med Wochenschr

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SummaryDescribed herein is a case of distended abdomen in a 4-year-old boy with a ventriculoperitoneal (VP) shunt due to bilateral intraventricular hemorrhage following premature birth. Physical examination and laboratory tests revealed tenderness in the lower quadrants, with mild leukocytosis and normal C‑reactive protein levels. X‑ray demonstrated an intact VP shunt catheter but cranial displacement of the large intestine. Ultrasonography confirmed a large pseudocyst around the VP shunt, with extension from the symphysis to the sternum. The distal part of the VP shunt was surgically revised and 2.5 l of cerebrospinal fluid were evacuated. The boy made a full clinical recovery. Conventional X‑rays, routinely used to confirm or exclude VP shunt continuity, may provide important clues regarding to the etiology of VP shunt dysfunction.

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Abdominal complications in patients with a ventriculoperitoneal shunt: proposal for management recommendations from a single pediatric tertiary center

Cited by 4 publications

References 31 publications

Appendicitis and Peritonitis in Children with a Ventriculo-Peritoneal Shunt

Appendicitis and Peritonitis in Children with a Ventriculo-Peritoneal Shunt

Valve pressure adjustments of cerebrospinal fluid shunts – longitudinal analysis of 614 patients

Distended abdomen due to a pseudocyst around a ventriculoperitoneal shunt

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