Laparoscopic management of distal ventriculoperitoneal shunt complications

Abstract

Regardless of the patient's presenting symptoms, appropriate imaging studies should be obtained preoperatively in a sequential manner. Distal VP shunt complications can be safely and effectively managed laparoscopically. This approach allows the intraabdominal portion of the catheter to be assessed and problems to be managed, thereby salvaging the existing shunt and avoiding the potential morbidity associated with additional VP shunt placement.

Incisional hernia after ventriculoperitoneal shunt

“…Complications that occur at the distal (abdominal) end are also a cause of significant morbidity, and in various series, nearly 5 -47 % of all shunt failures are thought to be due to malfunction of the distal catheter [4][5][6][7] with a higher incidence in patients with scoliosis, obesity and those who have undergone prior abdominal surgery [4,8]. Abdominal complications that have been reported are; shunt infection, development of an inguinal hernia, subcutaneous collections of CSF, peritoneal or omental cyst formation, mesenteric pseudotumors, bowel perforation, intestinal volvulus around the shunt tubing, catheter disconnection; and various types of catheter migrations such as extraperitoneal retraction and displacement, migration of the catheter into the pleural cavity or heart, or protrusion of the catheter through the mouth, umbilicus, bladder, vagina, anus, or scrotum.…”

“…Abdominal complications that have been reported are; shunt infection, development of an inguinal hernia, subcutaneous collections of CSF, peritoneal or omental cyst formation, mesenteric pseudotumors, bowel perforation, intestinal volvulus around the shunt tubing, catheter disconnection; and various types of catheter migrations such as extraperitoneal retraction and displacement, migration of the catheter into the pleural cavity or heart, or protrusion of the catheter through the mouth, umbilicus, bladder, vagina, anus, or scrotum. Knotting of the shunt has also been reported on occasion [1][2][3][4][5][6][7], as have been other less common complications such as adhesive bowel obstruction, intra-abdominal abscesses, cerebrospinal-enteric fistula and intractable CSF ascites [1,3].…”

Formation of Abdominal Cerebrospinal Fluid Pseudocyst

“…15) Abdominal CSF pseudocyst was first described in 1954, 10) and the incidence of these pseudocysts is less than 1% to 4.5%. 2,19) Most reported cases of CSF pseudocysts have occurred in children, with only 29 cases in adults.…”

“…2,19) Most reported cases of CSF pseudocysts have occurred in children, with only 29 cases in adults. [1][2][3][4][5]7,[11][12][13]15,[17][18][19][20]23) We describe the formation of an abdominal CSF pseudocyst in an adult, and review all 30 adult cases of abdominal CSF pseudocysts. Neurol Med Chir (Tokyo) 52, November, 2012…”

“…1,15) The advantages of the laparoscopic approach include shorter hospital stay because of less invasiveness and lower risk of forming postoperative adhesions and related complications compared with laparotomy. 1,15) Infection with Staphylococcus epidermis was detected in 3 of 18 cases examined for bacterial infection (excluding one study 19) in which 4 patients had infections, but were not identified as child or adult). Distal externalization of the peritoneal catheter was performed, antibiotic treatment was administered, and then the distal segment of the shunt tube was replaced in the 3 cases in which infection was detected.…”