Intra-Abdominal Complications Following Ventriculoperitoneal Shunt Procedures

Forty-five of 185 (24%) infants and children with hydrocephalus treated by ventriculoperitoneal (VP) shunt procedures developed intra-abdominal complications. The occurrence of a previously unrecognized inguinal hernia was noted in 31 patients (16.8%). The mean interval from VP shunt to hernia occurrence was 6.8 months. Seventy-five percent had bilateral findings and 20% were incarcerated. Perforation of the colon occurred in five patients and of the bladder in two. Intra-abdominal cerebrospinal fluid (CSF) cyst was noted in three cases, catheter disconnection in two, knotted catheter in one, and intestinal obstruction due to volvulus around a shunt in one. There was only one death. Abdominal x-ray was often diagnostic; demonstrating the VP-shunt catheter in the scrotum in six patients with otherwise unrecognized inguinal hernia, and in instances of knotted shunt, shunt disconnection, bladder perforation, CSF cysts, and intestinal obstruction. In addition, contrast studies in instances of shunt dysfunction documented bowel perforation and CSF cyst formation. These data indicate that intra-abdominal complications are not uncommon following VP-shunt operations. Close observation for development of previously unrecognized inguinal hernia and other intra-abdominal complications is advised following VP-shunt operations in infants with hydrocephalus.