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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Postprandial and postural dyspnea: Examination Three weeks after discharge the infant was readmitted to the hospital because of labored, tachypneic breathing, and frequent oxygen desaturation accompanied by bradycardia. 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.
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.
Hydrothorax is poorly tolerated in the very young and can lead to hypoxia and compensated respiratory acidosis, as we observed in our infant patient. Symptomatic treatment of the hydrothorax by means of needle thoracentesis, with conversion of the VP shunt to a ventriculoatrial shunt, corrects the problem.
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. During shunt surgery the peritoneal surfaces were observed to be thickened and the intestinal loops were matted together, suggesting that the diffusely present thick adhesions created a poor milieu for CSF absorption.
Three weeks after discharge the infant was readmitted to the hospital because of labored, tachypneic breathing, and frequent oxygen desaturation accompanied by bradycardia.
In instances of intrathoracic shunt migration or pleural cavity shunt penetration, repositioning of the shunt from the thoracic cavity into the abdomen corrects the problem.
Pediatria Medica e ChirurgicaVol. Symptomatic hydrothorax is an unusual postoperative complication after ventriculoperitoneal VP shunt placement and can become life threatening, especially in infants and small children. Pleural fluid and CSF obtained intraoperatively were again cultured, and neither grew any organisms even peritoneake 10 days of aerobic and anaerobic incubation. 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.
AB – The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting. Large pleural effusions, with or without pneumothorax, may become life threatening and require emergency treatment. Other problems included bronchopulmonary dysplasia and nonclosure of a patent ductus arteriosus requiring surgical ligation.
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Many observations have been dedicated to these pathological findings, due to their frequency and the relatively easy diagnosis. Serial dynamic images revealed radioactive contrast material throughout the ventriccolo shunt without evidence of obstruction or isotope leakage. Several chest x-ray films showed total resolution of hydrothorax within 1 week after surgery Fig. 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.
Link to citation list in Scopus. Dispnea postprandiale e da posizione: In the present report the authors describe two cases of intraperitoneal pseudocysts clinically manifested by the occurrence of postprandial dyspnea and hiccupping, without any apparent sign of CSF shunt device dysfunction.
Soon afterward the entire shunt system required revision because of blockage from cerebral debris. 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. She subsequently developed Grade IV ventricular hemorrhage. 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 partial collapse of the right lung.
Translated title of the contribution Postprandial and postural dyspnea: Pediatria Medica e Chirurgica. Access to Document Link to publication in Scopus. 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 was done with success in our infant patient.
Postoperative Course The patient had an uneventful postoperative recovery with complete resolution of respiratory difficulties. 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. Intraperitoneal pseudocysts are also a known complication of ventriculo-peritoneal shunts. During each shunt surgery dense adhesions were observed in the abdominal contents and peritoneal cavity. The three causal mechanisms advanced to explain the development of postoperative hydrothorax have been extensively reviewed by both Doh, et al.
Flow into the pelvis and paracolic spaces is likely the result of the effect of gravity when prone and upright positions are assumed.
A chest x-ray film revealed bilateral pleural effusions Fig. Delayed images demonstrating further isotope activity in the pleural cavity with a preferential flow pattern of CSF toward the superior abdominal region, diaphragm, and into the chest cavity.
AU – Palma, P. 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.
Respiratory exhalation produces passive stretching of peeritoneale diaphragm with rapid influx of fluid through the stomas into the lacunae. Most of the complications are related to the distal end of the shunt device and ventrlcolo obstruction of intraperitoneal catheter, development of inguinal hernia or hydrocele, perforation of viscera. 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.
Several complications may however occur following these operative procedures. At 30 minutes after the start of imaging radioactivity appeared in the thoracic region Fig. Pediatria Medica e Chirurgica15 2 Discussion This case is unique because hydrothorax occurred as a derivazioone of preferential transdiaphragmatic flow of CSF into the pleural cavity in the absence of ascites.
A 99m Tc-DTPA radionucleotide scan showing isotope flow into the chest cavity within 30 minutes and minimal presence of isotope in the peritoneal cavity. Anteroposterior chest x-ray film obtained 1 week after shunt revision demonstrating complete resolution of hydrothorax and expansion of the lungs.
A VP shunt was placed to treat communicating hydrocephalus after the necrotizing en-terocolitis venttricolo completely resolved, when there were no further gastrointestinal complications and after oral feeding had been well tolerated for several days.