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Torsion of omental cyst—A rare complication of ventriculoperitoneal shunt
Torsion
of Omental Cyst-A Raw Complication of Ven triculoperitoncal Shunt By Robert
A. Parrish,
M.D.,
Augusta,
and J. M. Potts, B.S. Ga.
A 4-mo-old boy was noted to have hydrocephalus at 2 wk of age and underwent ;i ventriculoperitoneal shunt. The patient did well until 2 days prior to the present admission. At that time the mother noticed one bloody stool, poor appetite. and irritability. On the day of admi\uion marked abdominal distention without vomiting occurred. The findings on admission included a pulse of 120/min, respirations 32/min, and a temperature of 38’C. The head circumference was 48 cm with wide sutures, a bulging anterior fontanelle, distended scalp veins,and a palpable shunt subcutaneously in the right parietal region. The pupils were sluggish and the muscle tone was slightly increased. There was a right subcostal surgical scar, a greatly distended abdomen, decreased bowel younds, and a 6 X 6-cm cystic mass in the right lower abdominal quadrant. The rectum was empty, but the mass could.be palpated in the right pelvis and appeared moderately tender. X-rays revealed distended large and small bowel with a mass in the right lower quadrant (Fig. 1). The diagnosis of intussusception was entertained and 3 barium enema revealed complete filling to the ileocecal junction but no iteal reflex of contract agent was evident. At the end of the X-ray examination, the mass had moved to the left upper abdominal quadrant. After adequate hydration and nasogastric suction, laparotomy ~vas performed via transverse supraumbilical incision. The shunt catheter was found to be encased in omentum which was tightly twisted upon itself several times. Below this twist was an omental cyst showing evidence of early strangulation, i.e., areas of recent hemorrhage. The cyst measured 6 X 6 cm and was filled with cerebrospinal fluid (Fig. 2). The pedicle of omentum with the cyst was excised after the torsion was relieved and the shunt catheter withdrawn. Inspection of the catheter tip revealed it to be open and therefore it was replaced low in the pelvis. The postoperative course \\a\ uneventful. To our knowledge this complication of ventriculoperitoneal shunts has not been reported. In the infant, placement of the shunt catheter low in the peritoneal cavity, away from the omentum. would appear to be a way of avoiding this complication.
Fig. 1. Admission roentgenogram of abdoman revealing marked distention and a mass in the right lower quadrant.
Journal of Pedratric Surgery, Vol 8. No 6 IDecember).
6cm
1973
CASE REPORTS
tightly twisted Fig. 2. Omentum shunt c:ath eter with cyst distal1‘Y.
around
of Omental Cyst-A Raw Complication of Ven triculoperitoncal Shunt By Robert
A. Parrish,
M.D.,
Augusta,
and J. M. Potts, B.S. Ga.
A 4-mo-old boy was noted to have hydrocephalus at 2 wk of age and underwent ;i ventriculoperitoneal shunt. The patient did well until 2 days prior to the present admission. At that time the mother noticed one bloody stool, poor appetite. and irritability. On the day of admi\uion marked abdominal distention without vomiting occurred. The findings on admission included a pulse of 120/min, respirations 32/min, and a temperature of 38’C. The head circumference was 48 cm with wide sutures, a bulging anterior fontanelle, distended scalp veins,and a palpable shunt subcutaneously in the right parietal region. The pupils were sluggish and the muscle tone was slightly increased. There was a right subcostal surgical scar, a greatly distended abdomen, decreased bowel younds, and a 6 X 6-cm cystic mass in the right lower abdominal quadrant. The rectum was empty, but the mass could.be palpated in the right pelvis and appeared moderately tender. X-rays revealed distended large and small bowel with a mass in the right lower quadrant (Fig. 1). The diagnosis of intussusception was entertained and 3 barium enema revealed complete filling to the ileocecal junction but no iteal reflex of contract agent was evident. At the end of the X-ray examination, the mass had moved to the left upper abdominal quadrant. After adequate hydration and nasogastric suction, laparotomy ~vas performed via transverse supraumbilical incision. The shunt catheter was found to be encased in omentum which was tightly twisted upon itself several times. Below this twist was an omental cyst showing evidence of early strangulation, i.e., areas of recent hemorrhage. The cyst measured 6 X 6 cm and was filled with cerebrospinal fluid (Fig. 2). The pedicle of omentum with the cyst was excised after the torsion was relieved and the shunt catheter withdrawn. Inspection of the catheter tip revealed it to be open and therefore it was replaced low in the pelvis. The postoperative course \\a\ uneventful. To our knowledge this complication of ventriculoperitoneal shunts has not been reported. In the infant, placement of the shunt catheter low in the peritoneal cavity, away from the omentum. would appear to be a way of avoiding this complication.
Fig. 1. Admission roentgenogram of abdoman revealing marked distention and a mass in the right lower quadrant.
Journal of Pedratric Surgery, Vol 8. No 6 IDecember).
6cm
1973
CASE REPORTS
tightly twisted Fig. 2. Omentum shunt c:ath eter with cyst distal1‘Y.
around