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.

Author: Grosho Tushakar
Country: Guyana
Language: English (Spanish)
Genre: Automotive
Published (Last): 9 December 2007
Pages: 147
PDF File Size: 17.93 Mb
ePub File Size: 12.2 Mb
ISBN: 915-2-46590-501-4
Downloads: 58037
Price: Free* [*Free Regsitration Required]
Uploader: Faejora

Case Report History This 4-month-old girl had been born at 24 weeks of gestation after premature rupture of the amniotic membranes.

During this interval symptomatic hydrocephalus was treated by withdrawing CSF via intermittent lumbar and ventricular punctures. Her abdomen was soft, nontender, and not distended.

Several chest x-ray films showed total resolution of hydrothorax within 1 week after peeritoneale Fig. This case is unique because hydrothorax occurred as a result of preferential ventircolo flow of CSF into the pleural cavity in the absence of ascites.

Translated title of the contribution 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.

Ospedale Pediatrico Bambino Gesu.

Large pleural effusions, with or without pneumothorax, may become life threatening and require emergency treatment. Symptomatic hydrothorax is an unusual postoperative complication after ventriculoperitoneal VP shunt placement and can become life threatening, especially in infants and small children. Flow into the pelvis and paracolic spaces is likely peritonezle result of the effect of gravity when prone and upright positions are assumed.

Several complications may however occur following these operative procedures. In this instance a pneumothorax frequently accompanies the hydrothorax. At 30 minutes after the start of imaging radioactivity appeared in the thoracic region Fig. AU – Palma, P. Subsequent images demonstrated increased accumulation in the thoracic region, and an intense area of radioactivity next to the diaphragm, consistent with communication of CSF between the abdominal and thoracic cavities 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 during this time with periodic needle thoracentesis, as was done with success in our infant patient.

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. Pediatria Medica e Chirurgica. Owing to their relative rare incidence and the aspecificity of their clinical presentation, this last type of complication has received a minor consideration. T he most common complications after shunt placement for cerebrospinal fluid CSF drainage to treat hydrocephalus are shunt infection and obstruction.


Second, the peritoneal tube can migrate through the diaphragm into the chest on its own or after an abdominal inflammatory process occurs. Pleural fluid and CSF obtained perutoneale were again cultured, and neither grew any organisms even after 10 days of aerobic and anaerobic incubation.

Symptomatic treatment of the hydrothorax by means of needle thoracentesis, with conversion of the Derivqzione shunt to a ventriculoatrial shunt, corrects the problem. The patient was followed petitoneale for 1 year and she thrived. She subsequently developed Grade IV ventricular hemorrhage.

Movement into the upper abdomen results from flow into a region of low pressure produced by absorption by diaphragmatic lymphatic structures and from a gravitational effect pulling the upper abdominal viscera away from the lower diaphragmatic surface. Guidelines for the treatment of hydrothorax may be gleaned from the few pritoneale cases in the literature. Link to citation list in Scopus. Studies in derivaaione undergoing dialysis have elucidated peritoneal fluid exchange rates and have shown that water and solutes cross the peritoneum in a passive, bidirectional flow.

Shunt cerebrale – Wikipedia

The three causal mechanisms advanced to explain the development of postoperative hydrothorax have been extensively reviewed by both Doh, et derivazioen.

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.

Anteroposterior chest x-ray film obtained 1 week after shunt revision demonstrating complete resolution of hydrothorax and expansion of the lungs.

Postoperative Course The patient had an uneventful postoperative recovery with complete resolution of respiratory difficulties. 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.

A chest x-ray film revealed bilateral pleural effusions Fig. Soon afterward the entire shunt system required revision because of blockage from cerebral debris. Diaphragmatic contraction during inspiration creates a negative intrathoracic pressure and empties the lymphatics into efferent ducts.


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. 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.

Shunt cerebrale

Pediatria Medica e Chirurgica15 2 AU peritojeale Velardi, F. Many observations have been dedicated to these pathological findings, due to their frequency and the relatively easy diagnosis. Anteroposterior x-ray film of the chest and abdomen showing the peritoneal tube of the Peritonealle shunt well positioned in peritpneale abdomen and bilateral pleural effusions with partial collapse of the right lung.

Radiological Evaluation We assessed shunt function and observed CSF flow by means of a radionucleotide study using 1. 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. Other problems included bronchopulmonary dysplasia and nonclosure of a patent prritoneale arteriosus requiring surgical ligation.

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. Hydrothorax is poorly tolerated in the very young and can lead to hypoxia and compensated respiratory acidosis, as we observed in our infant patient.

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.

Intraperitoneal pseudocysts are also a known complication of ventriculo-peritoneal shunts. The infant was treated initially with supplemental oxygen by means of a nasal cannula and needle thoracentesis.

We assessed shunt function and observed CSF flow by means of a radionucleotide study using 1. A meticulous dissection of the cavity was required to place the peritoneal tube. The surgical treatment of hydrocephalus has been greatly improved by the techniques of ventriculo-peritoneal shunting.

One-way valves in the thoracic lymphatic structures prevent retrograde fluid flow.