Abdominal Complications After Ventriculoperitoneal Shunt placement in Pediatric Patients with Hydrocephalus

Background: The insertion of a ventriculoperitoneal shunt is a necessary neurosurgical procedure to treat hydrocepha-lus. However, the placement of shunts can be associated with rare but significant postoperative abdominal complica-tions, which can subsequently lead to a range of problems. Materials and Methods: In this study, we reviewed case histories of patients with abdominal complications who previously underwent ventriculoperitoneal shunt insertion for hydrocephalus between 2008 and 2023 at single - institu-tion. Complications related to the abdomen were analysed. Results: During the 15-years observation period, a total 475 patients had a ventriculoperitoneal shunt placement. 101 (21,19%) patients with abdominal complications after ventriculoperitoneal shunt insertion were examined. Twelve patients (2,52%) who had shunt insertion out of peritoneal cavity and 245 (70,81%) patients with non- abdomen related complications were excluded from the study. Ninety seven patients (96,04%) required shunt revisions. Obstruction of abdominal end of the ventriculoperitoneal shunt occurred in 63 (62,38%) patients, cerebrospinal fluid pseudocyst of peritoneal cavity occurred in 27 (26,73%) patients. Twenty three patients (22,77%) had a large size of the pseudocyst with a cerebrospinal fluid volume more than 300 mL. Four patients (3,96%) had a pseudocyst with a cerebrospinal fluid volume less than 300 mL. Four patients (3,96%) had a medical conservative treatment. Risk factors for abdominal cerebrospinal fluid pseudocyst complications were intestinal adhesion and peritoneal thickness, for mechanical dysfunction of ventriculoperitoneal shunt were obstructions of the distal end by fat tissues and for extrusions were long distal end of the shunt. The rates of other rare complications such a spontaneous extrusion of the peritoneal catheter through the anus, urethra, inguinal canal and migration through the abdominal wall were < 1 (0,22%). Conclusions: All patients who will have treatment with ventriculoperitoneal shunts should be informed about the poten-tial abdominal complications. If there is any suspicion to abdomen related complications after ventriculoperitoneal shunt surgery all patients should be verified through imaging, followed by appropriate treatment. Although these complica-tions are rare, unrecognized and untreated cases can be fatal.