Ascites and abdominal pseudocysts following ventriculoperitoneal shunt surgery: variations of the same theme.
OBJECTIVE
Ascites and abdominal pseudocysts are two complications that can occur following placement of a ventriculoperitoneal (VP) shunt. Although various factors have been implicated, the exact pathogenesis of the two conditions remains elusive. To the authors' knowledge, there are no studies in which these two obviously related conditions have been compared.


METHODS
The authors retrospectively reviewed the cases of children with abdominal complications caused by a VP shunt. There were 15 patients who developed a pseudocyst and five patients who developed ascites. The cases were analyzed to identify common and distinguishing factors that may help in identifying the mechanism involved. Abdominal symptoms were the mode of presentation for patients with ascites, whereas shunt malfunction was the mode of presentation in 60% of those with pseudocysts. Culture-proven infection, abdominal surgery, and the number of revisions seemed to be more common in cases with pseudocysts than in ascites. The fluid in ascites was found to be a transudate irrespective of the origin of hydrocephalus. Alternative drainage sites were required in the treatment of patients with ascites, and reimplantation in the peritoneum was possible in 66.7% of those with pseudocysts. In the long-term, however, peritoneal reimplantation was possible in three of the five patients with ascites.


CONCLUSIONS
Abdominal pseudocysts and ascites, after VP shunt treatment, are distinct conditions with different modes of presentation and findings during examination of fluid, and therefore they require different management strategies.
Kariyattil
Rajeev
R
Division of Pediatric Neurosurgery, Department of Pediatric Surgery, British Columbia Children's Hospital, Children's and Women's Health Centre, Vancouver, British Columbia, Canada.
Steinbok
Paul
P
Singhal
Ashutosh
A
Cochrane
D Douglas
DD
D000005:Abdomen; D001201:Ascites / Q000209:etiology* / Q000378:metabolism / Q000382:microbiology; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D003560:Cysts / Q000209:etiology* / Q000382:microbiology; D004868:Equipment Failure; D005122:Exudates and Transudates / Q000378:metabolism; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery*; D007223:Infant; D007239:Infections / Q000209:etiology; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*