Abdominal pseudocysts and peritoneal catheter revisions: Surgical long-term results in pediatric hydrocephalus.

Abdominal pseudocysts and peritoneal catheter revisions: Surgical long-term results in pediatric hydrocephalus.

World Neurosurg. 2018 Jan 08;:

Authors: Gmeiner M, Wagner H, van Ouwerkerk WJR, Senker W, Holl K, Gruber A

Abstract
OBJECTIVE: An abdominal pseudocyst (APC) is a distal catheter site specific failure in patients treated with ventriculoperitoneal shunts and few studies with more than ten patients have been reported. The aim of this study was to analyze causes of peritoneal catheter revisions with special emphasis on revisions due to an APC.
METHODS: Pediatric patients with first shunt operation between 1982 and 1992 were included and time, cause and modality of peritoneal catheter revision were retrospectively determined.
RESULTS: 138 patients were treated for hydrocephalus and 112 received a peritoneal catheter during the follow-up. An APC was diagnosed in 14 (12.5%) patients and 28 revisions were needed for its treatment. The rate of shunt infection in APC patients was 50%, but in only three patients bacterial examination of the pseudofluid culture revealed infection. Age at first surgical procedure, type of first surgical procedure and etiology of hydrocephalus were not associated with APC diagnosis. APC recurred in 4 patients. These patients had a catheter repositioning directly into the peritoneum as first surgical treatment. No recurrences were observed in patients with shunt externalization and/or replacement of the peritoneal catheter.
CONCLUSION: An APC is a significant long-term complication after ventriculoperitoneal shunt treatment. Although a sterile inflammatory response cannot be completely excluded, our results favor the hypothesis of low-level shunt infection. In both cases the surgical consequences are the same. An infected APC should be treated as a shunt infection. Uninfected cases can be treated by shunt externalization and replacement of only the peritoneal catheter. (249 words).

PMID: 29325961 [PubMed - as supplied by publisher]

http://ift.tt/2EEgYfX