complicanza piu frequente e temibile delle derivazioni ventricolo-peritoneali. sterna di derivazione infettato, rappresentano le complicanze piu frequenti e. Iannelli, A., Puca, A., Calisti, A. () ‘Idrocele edernia inguinale dopo derivazione ventricolo peritoneale in età pediatrica. Pediatria del Medico Chirurgica. Dispnea postprandiale e da posizione: segno clinico di pseudocisti intraperitoneale in pazienti con idrocefalo e derivazione ventricolo-peritoneale. Pediatria.
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Studies in patients undergoing dialysis have elucidated peritoneal fluid exchange rates and have shown that water and solutes cross the peritoneum in a passive, bidirectional flow.
Large pleural effusions, with or without pneumothorax, may become life threatening and require emergency treatment. Respiratory distress as a presenting symptom of VP shunt malfunction is unusual, and as illustrated in our case, should be considered in the differential diagnosis of shunt malfunction. During this interval symptomatic hydrocephalus was treated by withdrawing CSF via intermittent lumbar and ventricular punctures.
The patient was followed postoperatively for 1 year and she thrived. The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting.
Many observations have been dedicated to these pathological findings, due to their frequency and the relatively easy diagnosis. Several chest x-ray films showed total resolution of hydrothorax within 1 week after surgery Fig. Several complications may however occur following these operative procedures. This case is different from others reported in the literature because CSF ascites was not present, there was no shunt migration or inadvertent chest penetration during shunt surgery, and a 99m Tc-diethylenetriamine pentaacetic acid DTPA radionucleotide study confirmed the presence of preferential transdiaphragmatic CSF flow.
She subsequently developed Grade IV ventricular hemorrhage.
Particulate matter, unlike fluids and solutes, is cleared via stomas between specialized mesothelial cells that overlie the lymphatic channels present on the diaphragmatic peritoneal surface. Soon afterward the entire shunt system required revision because of blockage from cerebral debris. Hydrothorax is poorly tolerated in the very young and can lead to hypoxia and compensated respiratory acidosis, as we observed in our infant patient. Most of the complications are related to the distal end of the shunt device and include obstruction of intraperitoneal catheter, development of inguinal hernia or hydrocele, perforation of viscera.
Owing to their relative rare incidence and the aspecificity of their clinical presentation, this last type of complication has received a minor consideration.
Shunt cerebrale – Wikipedia
In the present report the authors describe two cases of intraperitoneal pseudocysts clinically manifested by ventricoko occurrence of postprandial dyspnea and hiccupping, without any apparent sign of CSF shunt device dysfunction.
Postprandial and postural dyspnea: AU – Palma, P. We also recommend that pleural fluid and CSF be cultured for a minimum of 5 days to rule out indolent Staphylococcus epidermidis infection and that symptomatic hydrothorax be treated during this time with periodic needle thoracentesis, as deruvazione done with success in our infant patient.
Guidelines for the treatment of hydrothorax may be gleaned from the few reported cases in the literature.
The pathways of the flow of contrast material within the peritoneal cavity were defined by Autio. In addition, to our knowledge no 99m Tc-DTPA radioactive scan demonstrating preferential transdiaphragmatic CSF flow into the pleural cavity has been described in the literature.
The scarring caused a significantly decreased peritoneal absorptive ability and decreased peritoneal surface area and abdominal cavity voume. This condition was treated conservatively with 14 days of intravenously administered broad spectrum antibiotic medications. AU – Velardi, F. The patient had peritpneale uneventful postoperative recovery with complete resolution of respiratory difficulties.
Symptomatic treatment of the hydrothorax by means of needle thoracentesis, with conversion of the VP shunt to a ventriculoatrial shunt, corrects the problem. Prior to shunt revision, we recommend that pleural fluid and CSF be assessed for the presence of infection, because subpulmonic pleural effusions can arise as a result of peritoneal infection.
Intraperitoneal pseudocysts are also derlvazione known complication of ventriculo-peritoneal shunts. Operation Because the workup showed absence of shunt and pleural fluid infections and preferential flow of CSF from the peritoneal to the pleural cavity, the existing VP shunt was converted to a ventriculoatrial shunt.
Her abdomen was soft, nontender, and not distended. Anteroposterior chest x-ray film obtained 1 week after shunt revision demonstrating complete resolution of hydrothorax and expansion of the lungs.
N2 – The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting. Subsequent images demonstrated increased accumulation in the deruvazione region, and an intense area of radioactivity next to the ventdicolo, consistent with communication of CSF between the abdominal and thoracic cavities Fig. One-way valves in the thoracic lymphatic structures prevent retrograde fluid flow.
AU – Pancani, S. Veentricolo x-ray film of the chest and abdomen showing the peritoneal tube of the VP shunt well positioned in the abdomen and bilateral pleural effusions with partial collapse of the right lung.
Pediatria Medica e ChirurgicaVol. A VP shunt was placed to treat communicating hydrocephalus after the necrotizing en-terocolitis had completely resolved, when there were no further gastrointestinal complications and after oral feeding had been well tolerated for several days.
AB – The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting. In this instance a pneumothorax frequently accompanies the hydrothorax.
Discussion This case is unique because hydrothorax occurred as a result of preferential transdiaphragmatic flow vsntricolo CSF into the pleural cavity in the absence of ascites.
A chest x-ray film revealed bilateral pleural effusions Fig. During each shunt surgery dense adhesions were peritooneale in the abdominal contents and peritoneal cavity. Other problems included bronchopulmonary dysplasia and nonclosure of a patent ductus arteriosus requiring surgical ligation. Our experience teaches that hydrothorax after ventriculoperitoneal shunt placement in a premature infant may arise as an iatrogenic, postoperative complication of VP shunt surgery that is caused by preferential transdiaphragmatic flow of CSF into the pleural cavity from poor abdominal absorptive capacity of CSF.
The three causal mechanisms advanced to explain the development of postoperative hydrothorax have been extensively reviewed by both Doh, et al.
Translated title of the contribution Postprandial and postural dyspnea: Pediatria Medica e Chirurgica15 2 We assessed shunt function and observed CSF flow by means of a radionucleotide study using 1.