Management of sterile abdominal pseudocysts related to ventriculoperitoneal shunts

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>There are many known complications associated with CSF shunts. One of the more rare ones is a sterile abdominal pseudocyst due to decreased peritoneal absorption. This study was undertaken to detail the presentation, evaluation, and management of this unusual shunt-related event.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Patients presenting with ventriculoperitoneal shunt (VPS)–related sterile abdominal pseudocysts treated at two institutions between 2013 and 2018 were included. Patients who had undergone abdominal surgery or shunt revisions within a 12-month period preceding presentation were excluded. Information was collected regarding clinical characteristics; hospital course, including surgical intervention(s); and any subsequent complications. Special attention was given to the eventual surgery after pseudocyst resolution, including the use of laparoscopy for peritoneal catheter placement, distal shunt conversion (i.e., in the atrium or pleural cavity), endoscopic third ventriculostomy, or shunt removal. The timing and nature of any subsequent shunt failures were also noted.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Twenty-eight patients met the study criteria, with a mean age of 10 years. The most common etiology of hydrocephalus was intraventricular hemorrhage of prematurity. All shunts were externalized at presentation. One shunt was removed without subsequent internalization. Distal catheters were re-internalized back into the peritoneal cavity in 11 patients (laparoscopy was used in 8 cases). Fourteen shunts were converted to a ventriculoatrial shunt (VAS), and two to a ventriculopleural (VPlS). Two VPSs failed due to a recurrent pseudocyst. The total all-cause failure rates at 1 year were as follows: 18% for VPSs and 50% for VASs.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Following treatment of a VPS-related sterile abdominal pseudocyst, laparoscopy-assisted placement of the distal catheter in the peritoneum is a viable and safe option for select patients, compared to a VAS or VPlS.</jats:p></jats:sec>

The survival of reimplanted shunts following externalization: a single-institution cohort study

“…As opposed to shunt removal and external ventricular drain (EVD) insertion, however, shunt externalization avoids the need to access or remove the proximal catheter or valve. This procedure has become a core component in the management of shunt infections, 3 abdominal pseudocysts, 4 and other abdominal complications.…”

Extrahepatic pseudocyst in an adult

“…2 Some treatment algorithms have been described for the management of abdominal pseudocysts. 21,22 The shunt tap is the most vital step in the confirmation of further treatment requirements. If infection is initially eliminated, distal catheter repositioning is the only suitable method for the treatment of patients with sterile abdominal pseudocysts.…”

“…If the CSF is sterile, the peritoneal cavity, pleural space, atrium, or gallbladder can be used to reposition the distal catheter for patients who remain shunt-dependent. 22 Reaccumulation of pseudocysts remains a challenge for pediatric patients with abdominal pseudocysts who have undergone fluid drainage followed by the externalization or revision of shunts. 1 In a literature review of adult cases with hepatic pseudocysts, Dabdoub et al observed no recurrences after the revision of the shunt, even in cases of infection.…”