Pathophysiology and management of abdominal complications of ventriculo-peritoneal shunts

Abstract

The peritoneal cavity has gained a wide acceptance as the most desirable site for distal catheter implantation, especially in children. However, abdominal complications are far from rare when considering the lifespan of a pediatric patient. From a practical point of view, these complications can be classified as septic, like bowel perforation and peritoneal wound infection; likely aseptic like ascites, hernias, and lost peritoneal catheters; and dubious, like peritoneal pseudocyst, appendicitis, and CSF oozing. The pathophysiology, diagnosis, and management of these complications are detailed in the present section, ending with a list of tips proposed for complication avoidance. Related topics like surgery and pregnancy in the shunted patient will also be considered. These complications, inherent to the implantation of an inert catheter in a living and growing organism, should be known, anticipated, and part of the information given to the patient and his caretakers. The bright side is that in some fortunate cases, the outcome can be shunt independence, through shunt weaning or endoscopic procedure. In the end, in spite of its failures, the peritoneum generally remains the most desirable site for distal catheter re-implantation. At the time of primary insertion either, these potential complications do not undermine the status of the peritoneum as the preferred site, and atrial shunts are relegated to plan B. Nevertheless, the best shunt is clearly no shunt, and endoscopic management should be proposed first whenever possible. If atrial shunt is plan B and peritoneal shunt is plan A, endoscopy is plan 0.