Abdominal Complications in Patients with a Ventriculoperitoneal Shunt

*Yamila Marquez Basilotta, Romina Argañaraz and Beatriz Mantese*

## **Abstract**

Hydrocephalus is a complex disease. The placement of a ventriculoperitoneal shunt is a treatment that has been in use since the 1960s. Although in recent years, the development of the endoscopic technique has gained importance in the treatment of hydrocephalus, the use of valves continues to be used. Valves can be associated with different complications. In this chapter, we develop the abdominal complications associated with these devices. Both in patients with abdominal pseudocysts and with intestinal infections or ascites, they should be studied with brain tomography, x-rays of the valvular system, and ultrasound. The first step of treatment in these patients is to define if the valve works correctly or not. The second topic to take into account is the presence of infection associated with the catheter, which is detected by taking a sample of cerebrospinal fluid. The treatment of these valve-associated complications in many cases requires an approach involving multiple specialists, general practitioners, infectious diseases specialists, and general surgeons, among others. In patients with ventriculoperitoneal shunt-related abdominal complications, surgical treatment depends on symptom severity and the possible associated infection at the time of diagnosis.

**Keywords:** ventriculoperitoneal shunt, pseudocyst, bowel complications, ascites, abdominal complications

## **1. Introduction**

Hydrocephalus is a complex disease, common in childhood, that can cause permanent damage to the development of cognitive functions. Hydrocephalus results from an imbalance between cerebrospinal fluid (CSF) production and absorption. Within the physio pathogenesis, they are classically classified into communicating and noncommunicating hydrocephalus.

Noncommunicating or obstructive hydrocephalus is due to the presence of a lesion within the ventricular system that causes its obstruction with the consequent accumulation of cerebrospinal fluid, for example, stenosis of the sylvian aqueduct or tumors.

The ventriculoperitoneal valve placement technique was developed in the 1960s. The ventriculoperitoneal valve is made up of three parts, a tubing that is placed

intracranially, the valve reservoir, and the distal catheter that is inserted into the peritoneum. Despite the passing of the years, this treatment is currently used effectively in patients with communicating hydrocephalus [ 1 – 3 ].

 Although in recent years, the endoscopic technique has been developed for patients with obstructive hydrocephalus. Placement of a ventriculoperitoneal catheter continues to be used.

 The placement of ventriculoperitoneal valves is a surgery that is not free of complications. The most frequent VPS-related complications are infection and shunt malfunction. Shunt infection can be caused by various microorganisms. The causes of the malfunction of the shunt may be due to obstruction of the proximal catheter with choroid plexus (more frequent). The distal catheter can be cut with growth in pediatric patients. Occlusion of the valvular reservoir can also occur in patients with a large amount of protein in the cerebrospinal fluid, among others.

 There are other less frequent complications than infection and valve obstruction that involve the gastrointestinal tract. Within this group of pathologies are the abdominal pseudocyst (APC), ascites, or complications related to the intestine. Knowledge of possible abdominal diseases in patients with ventriculoperitoneal shunt is important for proper management in these cases [ 1 , 4 – 7 ]. In this chapter, we propose management guidelines for patients with VPS-associated abdominal complications, such as APC, bowel-related complications, and ascites based on our experience at a tertiary-care hospital [ 8 ].
