Pseudo-cistos peritoneais como complicação de derivações liquoricas: relato de 3 casos e contribuição para o diagnostico

Figueiredo, Djacir Gurgel de; Carvalho, Francisco Flavio Leitao de

doi:10.1590/S0004-282X1981000100006

Resumos

São relatados três casos de pseudocisto peritoneal sendo discutidos os seguintes aspectos principais para diagnóstico: aumento da pressão intraventricular com piora do quadro clínico; dor localizada no abdome; resistência à compressão da cápsula, ocorrência de coleção liquórica subcutânea em torno do cateter peritoneal. A confirmação diagnóstica é feita mediante simples método radiológico que é descrito. São discutidos aspectos relacionados à fisiopatogenia da formação do pseudocisto, bem como da formação da coleção subcutânea de líquido cefalorraqueano.

Three cases of peritonial pseudocysts are reported with guidelines for the diagnosis of this type of complication. The authors point out the value of the following signs: 1 - increase of ventricular pressure with worsenning of the clinical picture; 2 - localized pain in the abdomen; 3 - difficulty to depress the capsule; 4 - occurrence of subcutaneous collection of CSF around the pathway of the catheter. In some occasions it is possible to palpate the mass of the pseudocyst. The presence of subcutaneous collection of CSF around the pathway of t!ie catheter is an important warning sign of peritonial pseudocyst and must be differentiated from that originated by the disconnection between the capsule and the catheter. In this condition however, the accumulation of liquid begins in the cervical region. Also in this case the capsule depresses easily. The most precise diagnosis is achieved by X-Ray. The authors describe a method that consists in introducing a needle through the capsule and injecting 8cc of Dimer-X contrast. The catheter and the cavity of pseudo-cyst appear contrasted in the X-Ray film, stablishing the definitive diagnosis. The authors discuss the physiopathogeny of CSF accumulation; once the pseudocyst is formed, the intracranial pressure increases, and the fontanelle bulges, this leads to repeated pumping by the relatives and subsequent rising of pressure within the pseudo-cyst. At this point the patient refers pain at the location of the pseudo-cyst and the CSF tends to leak around catheter. In babies the abdominal pain leads to crying, thus increasing once more the intra-cystic pressure which favors the leakage of CSF from the pseudo-cyst around the catheter.

Pseudo-cistos peritoneais como complicação de derivações liquoricas: relato de 3 casos e contribuição para o diagnostico

Post shunt peritoneal pseudocysts: report of 3 cases

Djacir Gurgel de Figueiredo; Francisco Flavio Leitao de Carvalho

Departamento de Neurocirurgia, Universidade Federal do Ceará e Serviço de Neurocirurgia do Hospital Geral de Fortaleza do INAMPS. Fortaleza (CE). Brasil

RESUMO

São relatados três casos de pseudocisto peritoneal sendo discutidos os seguintes aspectos principais para diagnóstico: aumento da pressão intraventricular com piora do quadro clínico; dor localizada no abdome; resistência à compressão da cápsula, ocorrência de coleção liquórica subcutânea em torno do cateter peritoneal. A confirmação diagnóstica é feita mediante simples método radiológico que é descrito. São discutidos aspectos relacionados à fisiopatogenia da formação do pseudocisto, bem como da formação da coleção subcutânea de líquido cefalorraqueano.

SUMMARY

Three cases of peritonial pseudocysts are reported with guidelines for the diagnosis of this type of complication. The authors point out the value of the following signs: 1 - increase of ventricular pressure with worsenning of the clinical picture; 2 - localized pain in the abdomen; 3 - difficulty to depress the capsule; 4 - occurrence of subcutaneous collection of CSF around the pathway of the catheter. In some occasions it is possible to palpate the mass of the pseudocyst. The presence of subcutaneous collection of CSF around the pathway of t!ie catheter is an important warning sign of peritonial pseudocyst and must be differentiated from that originated by the disconnection between the capsule and the catheter. In this condition however, the accumulation of liquid begins in the cervical region. Also in this case the capsule depresses easily. The most precise diagnosis is achieved by X-Ray. The authors describe a method that consists in introducing a needle through the capsule and injecting 8cc of Dimer-X contrast. The catheter and the cavity of pseudo-cyst appear contrasted in the X-Ray film, stablishing the definitive diagnosis. The authors discuss the physiopathogeny of CSF accumulation; once the pseudocyst is formed, the intracranial pressure increases, and the fontanelle bulges, this leads to repeated pumping by the relatives and subsequent rising of pressure within the pseudo-cyst. At this point the patient refers pain at the location of the pseudo-cyst and the CSF tends to leak around catheter. In babies the abdominal pain leads to crying, thus increasing once more the intra-cystic pressure which favors the leakage of CSF from the pseudo-cyst around the catheter.

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1. ADELOYE, A. & OLUMIDE, A. A. - Abdominal complications of ventriculo-peri-toneal shunts in Nigerians. Internat. Surg. 62:525, 1977.
2. ADELOYE, A. - Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. J. Neurosurg. 38:758, 1973.
3. ANTUNES, A. C. M. & RIBEIRO, T. R. - Spontaneous umbilical fistula from ventriculo-peritoneal shunt drainage. J. Neurosurg. 43:481, 1975.
4. CASTROVIEJO, P.; MULA, F.; CASAS, C; BERMEJO, A. M. & OTERO, B. - Complication del shunt peritoneal por perforacion intestinal y extrusion del tubo por el ano. Espan. Pedit. 8:685, 1975.
5. CURRI, D.; BOLLINI, C; CARBONIN, C. & BENEDETTI, A. - Rare complication in the surgical therapy of hydrocephalus with ventriculo-peritoneal shunt. J. Neurosurg. Sci. 18:206, 1974.
6. DAVIDSON, R. I. - Peritoneal bypass in the treatment of hydrocephalus: historical review and abdominal complication. J. Neurol. Psychiat. a. Neurosurg. (London) 39:640, 1976.
7. DEWEY, R. C; KOSNIK, E. J. & SAYERS, M. P. - A simple test of shunt function: the shuntgram. J. Neurosurg. 44:121, 1976.
8. EVANS, R. C; THOMAS, M. D. & WILLIAMS, L. A. - Shunt blockage in hidrocephalic children: the use of valvogram. Clin. Radiol. 27:489, 1976.
9. EVANS, R. C; THOMAS, M. D. & WILLIAMS, L. A. - The use of the vaivogram tor the detection of shunt blockage in hidrocephalic children. Develop. Med. Child Nearol. (Suppl.) 35:94, 1975.
10. FISCHER, E. G. & SHILLITO, J. Large abdominal cysts: a complication of shunts: report of three cases. J. Neurosurg. 31:441, 1969.
11. GIFFORD, R. R. & PLAUT, M. R. - Abdominal catheter retraction in a ventriculo-peritoneal shunt. Clin. Pediatr. (Philadelphia) 13:84, 1974.
12. GIUFFRÉ, R. & LORENZO, N. D. - Two unusual complication of ventriculo-peritoneal shunt in the same infant. Surg. Neurol. 3:23, 1975.
13. GROSFELD, J. L.; COONEY, D. R.; SMITH, S. & CAMPBELL, R. L. - Intraabdominal complications following ventriculo-peritoneal shunt procedures. Pediatrics 154:791, 1974.
14. GUTIERREZ, F. A. & RAIMONDI, A. J. - Peritoneal cysts: a complication of ventriculo-peritoneal shunts. Surgery 79:188, 1976.
15. LAJAT, Y.: SAKTKE. R. L.: GUIHARD, D.; ITO, I.; FRESCHE, F.; COLLET, M. & DESCUNS. P. - Étude comparative des complications ventriculo-atriales et ventriculo-peritonéales: a propos de 10 cases. Neuro-Chirurg. (Paris) 21:147, 1975.
16. LEE, F. A. & GWINN, J. L. - Complications of ventriculo-peritoneal shunts. Ann. Radiol. 18:471, 1975.
17. MORINZO. J. R. & CAUTHEN, J. C. - Vaginal perforation by a Raimondi peritoneal catheter in an adult. Surgical Neurol. 2:195, 1974.
18. PATEL, C. D. & MATLOOB, H. - Vaginal perforation as a complication of ventriculo-peritoneal shunt. J. Neurosurg. 38:761, 1973.
19. PARRISH, R. A. & POTTS, J. M. - Torsion of omental cyst: a rare complication of ventriculo-peritoneal shunt. J. Pediatr. Surg. 8:969, 1973.
20. PARRY, S. W.: SCHUHMACHER, J. F. & LLEWLLYN, R. C. - Abdominal pseudocyst and ascites formation after ventriculo-peritoneal shunt procedures. J. Neurosurg. 43:476, 1975.
21. PEIRCE, K. R. & LOESER. J. D. - Perforation of the intestine by a Raimondi peritoneal catheter: a case report. J. Neurosurg. 39:775, 1973.
22. PORTNOY, H. D. & CROISSANT, P. D. - Two unusual complications of ventriculo-peritoneal shunt: case report J. Neurosurg. 39:775, 1973.
23. RAMANI, P. S. - Extrusion of abdominal catheter of ventriculo-peritoneal shunt into the scrotum: a case report. J. Neurol. 40:772, 1974.
24. RESJÖ, M. & RÄDBERG, C. - Patency of ventriculo-atrial shunt determined. Acta Radiol. 16:241, 1975.
25. RICCIO, H. & OCCHIPINTI, E. - Unusual late complications of ventriculo-atrial shunts: a case report. J. Neurol. Sci. 19:195, 1975.
26. ROSENTRHAL. J. D.: GOLDEN, G. T.; SHAW, C. A. & JANE, P. A. - Intractable ascites: a complication of ventriculo-peritoneal shunting with a silastic catheter. Amer. J. Surg. 127:613, 1974.
27. SELLS, C. J. & LOESER. J. D. - Peritonitis following perforation of the bowel a rare complication of a ventriculo-peritoneal shunt. J. Pediatr. 83:823. 1973.
28. WETDMANN, M. J. - Ascites from a ventriculo-peritoneal shunt. J. Neurosurg. 43:223, 1975.

Datas de Publicação

Publicação nesta coleção
20 Ago 2012
Data do Fascículo
Mar 1981

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ADELOYE, A. & OLUMIDE, A. A. - Abdominal complications of ventriculo-peri-toneal shunts in Nigerians. Internat. Surg. 62:525, 1977.

[2] 2. ADELOYE, A. - Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. J. Neurosurg. 38:758, 1973.

[3] 3. ANTUNES, A. C. M. & RIBEIRO, T. R. - Spontaneous umbilical fistula from ventriculo-peritoneal shunt drainage. J. Neurosurg. 43:481, 1975.

[4] 4. CASTROVIEJO, P.; MULA, F.; CASAS, C; BERMEJO, A. M. & OTERO, B. - Complication del shunt peritoneal por perforacion intestinal y extrusion del tubo por el ano. Espan. Pedit. 8:685, 1975.

[5] 5. CURRI, D.; BOLLINI, C; CARBONIN, C. & BENEDETTI, A. - Rare complication in the surgical therapy of hydrocephalus with ventriculo-peritoneal shunt. J. Neurosurg. Sci. 18:206, 1974.

[6] 6. DAVIDSON, R. I. - Peritoneal bypass in the treatment of hydrocephalus: historical review and abdominal complication. J. Neurol. Psychiat. a. Neurosurg. (London) 39:640, 1976.

[7] 7. DEWEY, R. C; KOSNIK, E. J. & SAYERS, M. P. - A simple test of shunt function: the shuntgram. J. Neurosurg. 44:121, 1976.

[8] 8. EVANS, R. C; THOMAS, M. D. & WILLIAMS, L. A. - Shunt blockage in hidrocephalic children: the use of valvogram. Clin. Radiol. 27:489, 1976.

[9] 9. EVANS, R. C; THOMAS, M. D. & WILLIAMS, L. A. - The use of the vaivogram tor the detection of shunt blockage in hidrocephalic children. Develop. Med. Child Nearol. (Suppl.) 35:94, 1975.

[10] 10. FISCHER, E. G. & SHILLITO, J. Large abdominal cysts: a complication of shunts: report of three cases. J. Neurosurg. 31:441, 1969.

[11] 11. GIFFORD, R. R. & PLAUT, M. R. - Abdominal catheter retraction in a ventriculo-peritoneal shunt. Clin. Pediatr. (Philadelphia) 13:84, 1974.

[12] 12. GIUFFRÉ, R. & LORENZO, N. D. - Two unusual complication of ventriculo-peritoneal shunt in the same infant. Surg. Neurol. 3:23, 1975.

[13] 13. GROSFELD, J. L.; COONEY, D. R.; SMITH, S. & CAMPBELL, R. L. - Intraabdominal complications following ventriculo-peritoneal shunt procedures. Pediatrics 154:791, 1974.

[14] 14. GUTIERREZ, F. A. & RAIMONDI, A. J. - Peritoneal cysts: a complication of ventriculo-peritoneal shunts. Surgery 79:188, 1976.

[15] 15. LAJAT, Y.: SAKTKE. R. L.: GUIHARD, D.; ITO, I.; FRESCHE, F.; COLLET, M. & DESCUNS. P. - Étude comparative des complications ventriculo-atriales et ventriculo-peritonéales: a propos de 10 cases. Neuro-Chirurg. (Paris) 21:147, 1975.

[16] 16. LEE, F. A. & GWINN, J. L. - Complications of ventriculo-peritoneal shunts. Ann. Radiol. 18:471, 1975.

[17] 17. MORINZO. J. R. & CAUTHEN, J. C. - Vaginal perforation by a Raimondi peritoneal catheter in an adult. Surgical Neurol. 2:195, 1974.

[18] 18. PATEL, C. D. & MATLOOB, H. - Vaginal perforation as a complication of ventriculo-peritoneal shunt. J. Neurosurg. 38:761, 1973.

[19] 19. PARRISH, R. A. & POTTS, J. M. - Torsion of omental cyst: a rare complication of ventriculo-peritoneal shunt. J. Pediatr. Surg. 8:969, 1973.

[20] 20. PARRY, S. W.: SCHUHMACHER, J. F. & LLEWLLYN, R. C. - Abdominal pseudocyst and ascites formation after ventriculo-peritoneal shunt procedures. J. Neurosurg. 43:476, 1975.

[21] 21. PEIRCE, K. R. & LOESER. J. D. - Perforation of the intestine by a Raimondi peritoneal catheter: a case report. J. Neurosurg. 39:775, 1973.

[22] 22. PORTNOY, H. D. & CROISSANT, P. D. - Two unusual complications of ventriculo-peritoneal shunt: case report J. Neurosurg. 39:775, 1973.

[23] 23. RAMANI, P. S. - Extrusion of abdominal catheter of ventriculo-peritoneal shunt into the scrotum: a case report. J. Neurol. 40:772, 1974.

[24] 24. RESJÖ, M. & RÄDBERG, C. - Patency of ventriculo-atrial shunt determined. Acta Radiol. 16:241, 1975.

[25] 25. RICCIO, H. & OCCHIPINTI, E. - Unusual late complications of ventriculo-atrial shunts: a case report. J. Neurol. Sci. 19:195, 1975.

[26] 26. ROSENTRHAL. J. D.: GOLDEN, G. T.; SHAW, C. A. & JANE, P. A. - Intractable ascites: a complication of ventriculo-peritoneal shunting with a silastic catheter. Amer. J. Surg. 127:613, 1974.

[27] 27. SELLS, C. J. & LOESER. J. D. - Peritonitis following perforation of the bowel a rare complication of a ventriculo-peritoneal shunt. J. Pediatr. 83:823. 1973.

[28] 28. WETDMANN, M. J. - Ascites from a ventriculo-peritoneal shunt. J. Neurosurg. 43:223, 1975.