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.
|Published (Last):||18 July 2005|
|PDF File Size:||5.70 Mb|
|ePub File Size:||18.5 Mb|
|Price:||Free* [*Free Regsitration Required]|
Postoperative Course The patient had an uneventful postoperative recovery with complete resolution of respiratory difficulties.
Pediatria Medica e Chirurgica15 2 Pediatria Medica e Chirurgica. During each shunt surgery dense adhesions were observed in the abdominal contents and peritoneal cavity.
The tube migrates through a preexisting hiatus, or through the anterior foramen of Morgagni or posterior foramen of Bochdalek, the two congenital hiatuses where the diaphragmatic musculature ventrlcolo thinnest along its fibroareolar sternocostal and lumbocostal margins.
In this instance a pneumothorax frequently accompanies the hydrothorax. 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. The patient was followed postoperatively for 1 year and she thrived.
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. Anteroposterior 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 vetnricolo collapse of the right lung.
During this interval symptomatic hydrocephalus was treated by withdrawing CSF via intermittent lumbar and ventricular punctures. Soon afterward the entire shunt system required revision because of blockage from cerebral debris. Our experience teaches that hydrothorax after ventriculoperitoneal shunt placement in a ventricool 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.
At 30 minutes after the start of imaging radioactivity appeared in the thoracic region Fig. 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 peritonea,e this time with periodic gentricolo thoracentesis, as was done with success in our infant patient.
We report on a case of CSF hydrothorax that developed after VP shunt placement in a premature infant with poor abdominal Dericazione absorption capacity resulting from intense abdominal scarring that was caused by an episode of necrotizing derivqzione.
AU – Palma, P.
This 4-month-old girl had been born at vsntricolo weeks of gestation after premature rupture of the amniotic membranes.
In instances of intrathoracic shunt migration or pleural cavity shunt penetration, repositioning of the shunt from the thoracic cavity perktoneale the abdomen corrects the problem. Pediatria Medica e ChirurgicaVol. The salient anatomical and physiological features of the peritoneal cavity have been summarized by Rotstein and Simmons.
The patient had an uneventful postoperative recovery with complete resolution of respiratory difficulties. Ospedale Pediatrico Bambino Gesu.
The infant was treated initially with supplemental oxygen by means of a nasal cannula and needle thoracentesis. Respiratory distress as a presenting symptom of VP shunt malfunction is unusual, and as illustrated in our peritnoeale, should be considered in the differential diagnosis of shunt malfunction.
Shunt cerebrale – Wikipedia
This forced CSF to flow preferentially in a superior direction toward the diaphragmatic lymphatic structures, where it was drawn by negative intrathoracic pressure into the pleural cavity for absorption.
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. The three causal mechanisms advanced to explain the development of postoperative hydrothorax have been extensively reviewed by both Doh, et al.
We postulate that in our patient diffuse peritoneal surface scarring resulting from necrotizing enterocolitis created a milieu that interfered with the normal mechanisms of fluid and solute absorption.
Postprandial and postural dyspnea: The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting. Several complications may however occur following these operative procedures. This case is unique because hydrothorax occurred as a result of preferential transdiaphragmatic flow of CSF into the pleural cavity in the absence of ascites.
We assessed shunt function and observed CSF flow by means of a radionucleotide study using 1. Abstract The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting. The pathways of the flow of contrast material within the peritoneal cavity were defined by Autio. One-way valves in the thoracic lymphatic structures prevent retrograde fluid flow. Arterial blood gas and serum electrolyte testing showed hypoxia and compensated respiratory acidosis.
Hydrothorax is poorly tolerated in the very young and can lead to hypoxia and compensated respiratory acidosis, as we observed in our infant patient. Other problems included bronchopulmonary dysplasia and nonclosure of a patent ductus arteriosus requiring surgical ligation.
Flow into ventrricolo pelvis and paracolic spaces is likely the result of the effect of gravity when prone and upright positions are assumed. 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. At discharge the infant was observed to have a soft, nondistended abdomen, and an x-ray film series of the VP shunt showed the peritoneal tube to be well placed in the abdominal cavity.
A meticulous dissection of the cavity was required to place the peritoneal ventricklo. Owing to their relative rare incidence and the aspecificity of their clinical presentation, this last type of complication has received a minor consideration. Second, the peritoneal tube can migrate through the diaphragm into the chest on its own or after an abdominal inflammatory process occurs.
T he most common complications after shunt placement for cerebrospinal fluid CSF drainage to treat hydrocephalus are shunt infection and obstruction. Dispnea postprandiale e da posizione: