Abdominal Complications of Peritoneal Shunts

  • Matthieu Vinchon
  • Patrick Dhellemmes


The prognosis of hydrocephalus changed dramatically when shunts were introduced during the second half of the last century. Following the experience with atrial shunts, the peritoneum has become the most popular site for distal catheter implantation. Comparing these two main sites, some authors noticed that, although peritoneal shunts did not have fewer complications than atrial shunts, these complications were less severe and carried a decidedly lower mortality [37]. The risk of sudden death due to pulmonary embolism, in particular, makes the atrial catheter a less attractive option than the peritoneal catheter [6]. Also, the length of the catheter is limited in atrial shunts, whereas it is not in peritoneal shunts; in children, the number of elective revisions required to lengthen atrial catheters is forbidding [60].


Bowel Perforation Shunt Patient Shunt Infection Shunt Revision Shunt Malfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Addiss DG, Shaffer N, Fowler BS, et al: The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925, 1990PubMedGoogle Scholar
  2. 2.
    Baird C, O’Connor D, Pittman T: Late shunt infections. Pediatr Neurosurg 31:269–273, 1999PubMedCrossRefGoogle Scholar
  3. 3.
    Besson R, Hladky JP, Dhellemmes P, et al: Peritoneal pseudocyst: peritoneal shunt complications. Eur J Surg 5:195–197, 1995Google Scholar
  4. 4.
    Britz GW, Kim K, Loeser JD: Hydrocephalus secondary to diffuse villous hyperplasia of the choroid plexus. J Neurosurg 85:689–691, 1996PubMedCrossRefGoogle Scholar
  5. 5.
    Burchianti M, Cantini R: Peritoneal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunts. Child’s Nerv Syst 4:286–290, 1988Google Scholar
  6. 6.
    Byard RW: Mechanisms of sudden death and autopsy findings in patients with Arnold-Chiari malformation and ventriculoatrial catheters. Am J Forensic Med Pathol 17:260–263, 1996PubMedCrossRefGoogle Scholar
  7. 7.
    Casey KF, Vries JK: Cerebrospinal fluid overproduction in the absence of tumor or villous hypertrophy of the choroid plexus. Child’s Nerv Syst 5:332–334, 1989CrossRefGoogle Scholar
  8. 8.
    Cinalli G, Salazar C, Mallucci C, et al: The role of endoscopic third ventriculostomy in the management of shunt malfunction. Neurosurgery 43:1323–1329, 1998PubMedGoogle Scholar
  9. 9.
    Clarnette TD, Lam SK, Hutson JM: Ventriculo-peritoneal shunts in children reveal the natural history of closure of the processus vaginalis. Pediatr Surg 33:413–416, 1998CrossRefGoogle Scholar
  10. 10.
    Clyde BL, Albright AL: Evidence of a patent fibrous tract in fractured, outgrown, or disconnected ventriculoperitoneal shunts. Pediatr Neurosurg 23:20–25, 1995PubMedCrossRefGoogle Scholar
  11. 11.
    Cornips E, Van Calenbergh F, Plets C, et al: Use of external drainage for posthemorrhagic hydrocephalus in very low birth weight premature infants. Child’s Nerv Syst 13:369–374, 1997CrossRefGoogle Scholar
  12. 12.
    Cusimano MD, Meffe FM, Gentili F, et al: Management of pregnant women with cerebrospinal fluid shunts. Pediatr Neurosurg 17:10–13, 1991PubMedCrossRefGoogle Scholar
  13. 13.
    Danismend N, Kuday C: Unusual complication of ventriculoperitoneal shunt. Neurosurgery 22:798, 1988PubMedCrossRefGoogle Scholar
  14. 14.
    Davidson RI, Lingley JF: Intraperitoneal pseudocyst: treatment by aspiration. Surg Neurol 4:33–36, 1975PubMedGoogle Scholar
  15. 15.
    Dean DF, Keller IB: Cerebrospinal fluid ascites: a complication of a ventriculoperitoneal shunt. J Neurol Neurosurg Psychiatr 35:474–476, 1972PubMedCrossRefGoogle Scholar
  16. 16.
    Di Rocco C: The treatment of infantile hydrocephalus. CRC Press, Boca Raton, 1987Google Scholar
  17. 17.
    Di Rocco C, Marchese E, Velardi F: A survey of the first complication of newly implanted CSF devices for the treatment of nontumoral hydrocephalus. Child’s Nerv Syst 10:321–327, 1994CrossRefGoogle Scholar
  18. 18.
    Egelhoff J, Babcock DS, McLaurin R: Cerebrospinal fluid pseudocysts: sonographic appearance and clinical management. Pediatr Neurosci 12:80–86, 1985PubMedCrossRefGoogle Scholar
  19. 19.
    Faillace WJ, Garrison RD: Hydrothorax after ventriculoperitoneal shunt placement in a premature infant: an iatrogenic postoperative complication. J Neurosurg 88:594–597, 1998PubMedCrossRefGoogle Scholar
  20. 20.
    Fischer EG, Shillito J: Large abdominal cysts: a complication of peritoneal shunts. J Neurosurg 31:441–444, 1969PubMedCrossRefGoogle Scholar
  21. 21.
    Gaskill SJ, Cossman RM, Hiskman MS, et al: Laparoscopic surgery in a patient with a ventriculoperitoneal shunt: a new technique. Pediatr Neurosurg 28:106–107, 1998PubMedCrossRefGoogle Scholar
  22. 22.
    Gaskill SJ, Marlin AE: Spontaneous bacterial peritonitis in patients with ventriculoperitoneal shunts. Pediatr Neurosurg 26:115–119, 1997PubMedCrossRefGoogle Scholar
  23. 23.
    Gonzalez MG: Extrusion of peritoneal catheter through the anus. Child’s Nerv Syst 3:183–184, 1987CrossRefGoogle Scholar
  24. 24.
    Griffith JA, De Feo D: Peroral extrusion of a ventriculoperitoneal shunt catheter. Neurosurgery 21:259–261, 1987PubMedCrossRefGoogle Scholar
  25. 25.
    Hadani M, Findler G, Muggia-Sullam M, et al: Acute appendicitis in children with a ventriculoperitoneal shunt. Surg Neurol 18:69–71, 1982PubMedCrossRefGoogle Scholar
  26. 26.
    Hahn YS, Engelhard H, McLone DG: Abdominal CSF pseudocysts: clinical features and surgical management. Pediatr Neurosci 12:75–79, 1985PubMedCrossRefGoogle Scholar
  27. 27.
    Heggers JP, Kossovsky N, Parsons RW, et al: Biocompati-bility of silicone implants. Ann Plast Surg 11:38–45, 1983PubMedCrossRefGoogle Scholar
  28. 28.
    Horikawa M, Yamada T, Tominaga K, et al: Abdominal cerebrospinal pseudocyst in a severely handicapped patient with hydrocephalus. J Child Neurol 14:329–331, 1999PubMedCrossRefGoogle Scholar
  29. 29.
    Jones RFC, Stening WA, Kwok BCT, Sands TM (1993) Third ventriculostomy for shunt infections inchildren. Neurosurgery 32:855–860PubMedCrossRefGoogle Scholar
  30. 30.
    Körner H, Söndenaa K, Söreide JA, et al: Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21:313–317, 1997PubMedCrossRefGoogle Scholar
  31. 31.
    Kwok CK, Yue CP, Wen HL: Bilateral scrotal migration of abdominal catheters: a rare complication of ventriculoperitoneal shunts. Surg Neurol 31:330–331, 1989PubMedCrossRefGoogle Scholar
  32. 32.
    Langmoen IA, Lundar T, Vatne K, et al: Occurrence and management of fractured peripheral catheters in CSF shunts. Child’s Nerv Syst 8:222–225, 1992CrossRefGoogle Scholar
  33. 33.
    Latchaw JP, Hahn JF: Intraperitoneal pseudocysts: mimicking liver disease. Monogr Neural Sci 8:55–56, 1982Google Scholar
  34. 34.
    Leibrock L, Baker R, Uematsu S: Simulated acute appendicitis secondary to ventriculoperitoneal shunt. Surg Neurol 4:481–482, 1975PubMedGoogle Scholar
  35. 35.
    Lejeune JP, Sion P, Combelles G, et al: Pseudo-kistes péri-tonéaux de L.C.R.: complication rare des dérivations ven-triculo-péritonéales. Neurochirurgie 30:235–223, 1983Google Scholar
  36. 36.
    Magee JF, Barker NE, Blair GK, et al: Inguinal herniation with glial implants: possible complication of ventriculoperitoneal shunting. Pediatr Pathol Lab Med 16:591–596, 1996PubMedCrossRefGoogle Scholar
  37. 37.
    Mazza C, Pasqualin A, Da Pian R: Results of treatment with ventriculoatrial and ventriculoperitoneal shunt in infantile nontumoral hydrocephalus. Child’s Brain 7:1–14, 1980PubMedGoogle Scholar
  38. 38.
    Moss SD, Pattisapu JV, Walker ML: Use of the peritoneal trocar in pediatric shunt procedures. Concepts Pediatr Neurosurg 8:23–28, 1988Google Scholar
  39. 39.
    Nakagaki H, Matsunaga M, Maeyama R, et al: Intraperitoneal pseudocyst after ventriculoperitoneal shunt. Surg Neurol 11:447–450, 1979PubMedGoogle Scholar
  40. 40.
    Oatridge A, Holdcroft A, Saeed N, et al: Change in brain size during and after pregnancy: study in healthy women and women with preeclampsia. Am J Neuroradiol 23:19–26, 2002PubMedGoogle Scholar
  41. 41.
    Oi S, Matsumoto S: Hydrocephalus in premature infants. Characteristics and therapeutic problems. Child’s Nerv Syst 5:76–82, 1989CrossRefGoogle Scholar
  42. 42.
    Oi S, Shose Y, Oshio T, et al: Intragastric migration of a ventriculoperitoneal shunt catheter. Neurosurgery 21:255–257, 1987PubMedCrossRefGoogle Scholar
  43. 43.
    Parry SW, Schuhmacher JF, Llewellyn RC: Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures: report of four cases. J Neurosurg 43:476–480, 1975PubMedCrossRefGoogle Scholar
  44. 44.
    Patel CD, Matloub H: Vaginal perforation as a complication of ventriculoperitoneal shunts. J Neurosurg 38:761–762, 1973PubMedCrossRefGoogle Scholar
  45. 45.
    Piatt JH: Cerebrospinal fluid shunt failure: late is different from early. Pediatr Neurosurg 23:133–139, 1995PubMedCrossRefGoogle Scholar
  46. 46.
    Pieper R, Kager L: The incidence of acute appendicitis and appendectomy. An epidemiological study of 971 cases. Acta Chir Scand 148:45–49, 1982PubMedGoogle Scholar
  47. 47.
    Pomeranz S, Rapapport HZ, Umansky F, et al: Technical note: the removal of free peritoneal catheters in the revision of ventriculoperitoneal shunts. Neurosurgery 22:436–438, 1988PubMedCrossRefGoogle Scholar
  48. 48.
    Pompili A, Cianfriglia F: Umbilical fistula as a complication of ventriculoperitoneal shunt. Surg Neurol 12:129–130, 1979PubMedGoogle Scholar
  49. 49.
    Pumberger W, Löbl M, Geissler W: Appendicitis in children with a ventriculoperitoneal shunt. Pediatr Neurosurg 28:21–26, 1998PubMedCrossRefGoogle Scholar
  50. 50.
    Rekate HL, Yonas H, White RJ, et al: The acute abdomen in patients with ventriculoperitoneal shunts. Surg Neurol 11:442–445, 1979PubMedGoogle Scholar
  51. 51.
    Rickert CH: Abdominal metastases of pediatric brain tumors via ventriculo-peritoneal shunts. Child’s Nerv Syst 14:10–14, 1998CrossRefGoogle Scholar
  52. 52.
    Roitberg BZ, Tomita T, McLone DG: Abdominal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunt in children. Pediatr Neurosurg 29:267–273, 1998PubMedCrossRefGoogle Scholar
  53. 53.
    Roth JS, Park AE, Gewirtz R: Minilaparoscopically assisted placement of ventriculoperitoneal shunts. Surg Endosc 14:461–463, 2000PubMedCrossRefGoogle Scholar
  54. 54.
    Rubin RC, Ghatak NR, Visudhipan P: Asymptomatic perforated viscus and gram-negative ventriculitis as a complication of valve-regulated ventriculoperitoneal shunts. J Neurosurg 37:616–618, 1972PubMedCrossRefGoogle Scholar
  55. 55.
    Rush DS, Walsh JW: Abdominal complications of CSF-peritoneal shunts. Monogr Neural Sci 8:52–54, 1982Google Scholar
  56. 56.
    Ryken TC: Idiopathic intracranial hypertension (pseudotumor cerebri), hydrocephalus, and ventriculoperitoneal shunts in pregnancy. In: Loftus CM (ed) Neurosurgical aspects of pregnancy. American Association of Neurological Surgeons, Park Ridge, Illinois, pp 165–176, 1996Google Scholar
  57. 57.
    Salomao JF, Leibinger RD: Abdominal pseudocysts complicating CSF shunting in infants and children. Pediatr Neurosurg 31:274–278, 1999PubMedCrossRefGoogle Scholar
  58. 58.
    Stamos JK, Kaufman BA, Yogev R: Ventriculoperitoneal shunt infections with gram-negative bacteria. Neurosurgery 33:858–862, 1993PubMedCrossRefGoogle Scholar
  59. 59.
    Touho H, Nakauchi M, Tasawa T, et al: Intrahepatic migration of a peritoneal catheter: case report. Neurosurgery 21:258–259, 1987PubMedCrossRefGoogle Scholar
  60. 60.
    Vernet O, Campiche R, de Tribolet N: Long-term results after ventriculo-atrial shunting in children. Child’s Nerv Syst 11:176–179, 1995CrossRefGoogle Scholar
  61. 61.
    Vinchon M, Noulé N, Soto-Ares G, et al: Subduroperitoneal drainage for traumatic subdural hematoma in infants: results with 244 cases. J Neurosurg 95:248–254, 2001Google Scholar
  62. 62.
    West GA, Berger MS, Geyer J: Childhood optic pathway tumors associated with ascites following ventriculoperitoneal shunt placement. Pediatr Neurosurg 21:254–259, 1994PubMedCrossRefGoogle Scholar
  63. 63.
    Williams NMA, Everson NW, Jackson D, et al: Is the incidence of acute appendicitis really falling? Ann R Coll Surg Engl 80:122–124, 1998PubMedGoogle Scholar
  64. 64.
    Wisoff JH, Kratzert KJ, Hanwerker SM, et al: Pregnancy in patients with cerebrospinal fluid shunts: report of a series and review of the literature. Neurosurgery 29:827–831, 1991PubMedCrossRefGoogle Scholar
  65. 65.
    Yount RA, Glazier MC, Mealey J, et al: Cerebrospinal fluid ascites complicating ventriculoperitoneal shunting. J Neurosurg 61:180–183, 1984PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2005

Authors and Affiliations

  • Matthieu Vinchon
    • 1
  • Patrick Dhellemmes
    • 1
  1. 1.Department of Pediatric NeurosurgeryLille University Hospital, CHRU de LilleLilleFrance

Personalised recommendations