Чемпионат по редким осложнениям

[МУХАЛАБЕ]

Похоже, что выхожу в чемпионы по число леченных внутри абдоминальных осложнений вентрикуло-абдоминальных шунтов у детишек с гидроцефалией...

Даже в публикации из клиники Мэйо представлен всего один случай, а я за последнии три месяца оперировал троих детишек..

Bowel perforation complicating ventriculoperitoneal shunt: Case report and review???
Mahmoud M. Yousfi, MD, Norman S. Jackson, PA, Maher Abbas, MD, Richard S. Zimmerman, MD, David E. Fleischer, MD
Current affiliations: Department of Medicine, Division of Gastroenterology and Hepatology, Department of Surgery, Department of Neurosurgery, Mayo Clinic, Scottsdale, Arizona


DOI: http://dx.doi.org/10.1067/mge.2003.324

Article Infoclick to expand contents

Ventriculoperitoneal (VP) shunts, which divert cerebrospinal fluid (CSF), are effective in the management of hydrocephalus. The procedure is associated with various complications, 25% of which are abdominal.1 Bowel perforation by a VP shunt is rare; when it occurs, the patient may be asymptomatic, or it may result in serious infectious complications or death. Since Wilson and Bertan2 first described this complication in 1966, more than 60 cases have been reported. The overall frequency of bowel perforation is 0.01% to 0.07%. It may occur several weeks to many years after shunt placement. A case of spontaneous bowel perforation as a complication of distal VP shunt migration is described. Published information concerning this complication is reviewed, and the role of endoscopy in management is emphasized. A 24-year-old woman with a history of congenital hydrocephalus and multiple VP shunt revisions presented with a complaint of a foreign body protruding through her anus. It was noticed shortly after having a bowel movement earlier in the day. The patient had undergone more than 15 VP shunt revisions. Thirty months before presentation, a retained ventricular catheter had been removed and an external ventricular drain placed. A second, right occipital ventricular catheter was not removed because it could not be located. Five months before presentation, the patient was seen because of dyspepsia and generalized abdominal pain that had been present for years. There was no change in weight, irregularity in bowel habit, melena, hematochezia, nausea, vomiting, or fever. There was a history of multiple abdominal surgeries in association with the VP shunt revisions. A trial of therapy with a proton pump inhibitor was prescribed, and the patient was asked to return in 6 weeks. If the pain continued, further evaluation including endoscopy and CT was to be considered. The VP shunt is a standard device used to correct hydrocephalus. The essential components are a proximal catheter, which is placed into the cerebral ventricle, a valve, and a distal catheter that is placed in the peritoneal cavity. Long-term patency and inertness relative to human tissue are essential for successful VP shunt function.3 The rigidity of some distal catheters, such as that placed in our patient, was increased by incorporating a thin spiral wire in the catheter wall in an attempt to achieve long-term patency. This type of catheter has been associated with perforation through the vagina,4 small and large intestine,5 stomach, flank, diaphragm, neck, uterus, and scrotum, and even through the peritoneum and out through the thigh.6 These complications have also occurred with other types of VP shunts.

?Reprint requests: David E. Fleischer, MD, Chief, Division of Gastroenterology and Hepatology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ 85259.

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У этого 3 мес бэби образовался каловый свищ , вызванный внедрением катетера в кишку..

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Всё время спрашиваю у нейрохирургов: зачем вы запихиваете такой длинный катетер в живот ребёночку?
Ответа не получаю..

[Aleksei]