Intraabdominal pseudocysts as a complication of ventriculoperitoneal shunts
| Autor: | Jeffrey D. Kerby, Chris M Anderson, Donald L. Sorrells |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
Adult
medicine.medical_specialty Subarachnoid hemorrhage Adolescent medicine.medical_treatment Ventriculoperitoneal Shunt Cerebrospinal fluid Laparotomy Hydrocele Abdomen medicine Humans Child Intracranial pressure business.industry Cysts Infant Middle Aged medicine.disease Hydrocephalus Surgery Volvulus Bowel obstruction Child Preschool Radiology business |
| Zdroj: | Journal of the American College of Surgeons. 196(2) |
| ISSN: | 1072-7515 |
| Popis: | Ventriculoperitoneal (VP) shunts are the predominant mode of therapy for children with hydrocephalus. VP shunts divert cerebrospinal fluid (CSF) away from the ventricles, preventing increases in intracranial pressure that might lead to neurologic sequelae. The peritoneal cavity is an ideal place for CSF diversion because the fluid is efficiently and rapidly absorbed. VP shunts are used routinely to treat hydrocephalus resulting from various neurologic congenital abnormalities, subarachnoid hemorrhage, and tumors. The first description of shunting cerebrospinal fluid into the peritoneum was by Ferguson in 1898, when he passed a U-shaped silver wire from the subarachnoid space to the peritoneum through the fifth lumbar vertebra. Reported outcomes were dismal; one patient died shortly after operation and the other died 3 months later after some improvement. Nicoll fashioned an anatomic shunt by attaching omentum to a spinal dura defect in 1905. In the same year, Kausch used the first rubber ventriculoperitoneal shunt in a patient who survived for 2 years with a brain tumor. Autopsy revealed a scarred, yet patent rubber VP shunt. Cushing persisted with the use of a silver cannula passed through the lumbar vertebra. He quickly abandoned this technique after 2 of 12 patients died from intussusception. The modern VP shunt era for the treatment of hydrocephalus was started in 1948 by Cone, Lewis, and Jackson and later by Ames. Ames’ technique and outcome are better publicized. He abandoned lumbar shunts in infants secondary to the small spinal canal size, so the ventricle was used exclusively in infants. During a 9-year period he placed approximately 120 VP shunts with only four deaths attributable to the operation, all from infection. During this same period, the longestfunctioning shunt known lasted 6 years. VP shunt placement today is not without potential complications. Frequently the distal intraabdominal tubing becomes kinked or obstructed by fibrous bands or omentum. Symptoms of increased intracranial pressure occur and require repeat laparotomy. Other noted shunt complications include infection, perforated viscus (eg, gallbladder or bowel) by direct catheter erosion, bowel obstruction, volvulus, ascites, hydrocele, scrotal entrapment, and ileus. Abdominal peritoneal pseudocysts (APC) are a relatively uncommon complication with reported occurrence rates of 0.7% to 4.5%. A total of 204 case reports of APC have been cited since the first by Harsh in 1954 (Table 1). With more patients surviving longer, the incidence of APC might increase. In addition, most of these patients present with abdominal complaints. The general surgeon, not the neurosurgeon, will frequently be called on to diagnose and treat APC. This review article discusses the etiology, presentation, diagnosis, and treatment of APC. |
| Databáze: | OpenAIRE |
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