Ventriculoperitoneal shunt distal dysfunction due to peritoneal malabsorption: etiologies and management strategies—An institutional review

This study aims to investigate the etiology, risk factors, and management outcomes of peritoneal malabsorption, including pseudocysts and non-hepatic ascites, as a complication of ventriculoperitoneal (VP) shunting in pediatric hydrocephalus patients, with a focus on identifying predictors of distal dysfunction and evaluating therapeutic strategies. A retrospective review was conducted on 81 unique pediatric patients (≤ 18 years) undergoing 113 VP shunt revision episodes at Akdeniz University Hospital (2019-2023). Variables included age, sex, catheter site, hydrocephalus type, revision history, axial deformity severity, and abdominal surgery history. Peritoneal malabsorption occurred in 10 patients (11 revision episodes; 10 pseudocysts and 1 non-hepatic ascites), were analyzed for risk factors and management outcomes, with a minimum 9-month follow-up using ultrasonography and CT scans. Peritoneal malabsorption occurred in 10 patients (11 revision episodes), with statistically significant risk factors including history of multiple previous revisions (OR 8.02, 95% CI 1.86-34.63, p = 0.002), prior peritoneal-breaching abdominal surgery (OR 11.81, 95% CI 2.73-51.04, p = 0.001), and axial deformity (OR 4.07, 95% CI 1.03-16.03, p = 0.034; 2.77-fold increase per severity grade, p = 0.027). Prior abdominal surgery was present in 60% of malabsorption patients vs. 11.3% without, including even minor procedures (e.g., PEG placement, appendectomy, inguinal hernia repair). Management achieved peritoneal salvage in 7 of 10 patients; 5 episodes required only one procedure, while 6 episodes involved multiple interventions, with 3 ultimately needing ventriculoatrial shunt conversion. This small single-center series identifies prior abdominal surgery, axial deformity, and history of multiple previous revisions as factors associated with peritoneal malabsorption in VP shunts, suggesting mechanical and inflammatory contributions. Management remains challenging, with variable success rates and significantly prolonged hospitalization. These findings highlight the need for preoperative risk assessment and larger studies to refine therapeutic strategies.