Expectoraçao de liquido cefalorraqueano: rara complicaçao de derivaçao ventriculoperitoneal

Ferreira, Nelson Pires; Costa Jr., Decio Martins; Flores, José A. M.

doi:10.1590/S0004-282X1980000400013

Resumos

É descrito o caso de uma paciente submetida a derivação ventrículo-peritoneal em que foi observada expectoração de líquido cefalorraqueano, como complicação.

A child, who had undergone ventriculoperitoneal shunting, presented with repeated episodes of pneumonia and expectoration of CSF. Chest x-ray demonstrated the presence of the shunt catheter in the base of the left lung. In the present case the distal end of the catheter perfored the diaphragm, entering the thoracic cavity through the pleura and penetrating the pulmonary parenchyma. CSF then flowed freely into the alveoli and bronchi and became expectorated during repeated bousts of coughing associated with pneumonia. This respiratory complication disappeared after the removal of the catheter. We theorize that the penetration of the catheter into the thoracic cavity was secundary to its displacement from the iliac fossa to the left infradiaphragmatic space between the spleen and the diaphragm where the intra-abdominal pressure is lowest. The respiratory movements and the hypertension inside the abdomen created a constant friction of the catheter against the diaphragm which was finally perforated, permitting the passage of the peritoneal end of the shunting device into the thoracic cavity and secundary penetration of the lung.

Expectoraçao de liquido cefalorraqueano: rara complicaçao de derivaçao ventriculoperitoneal

Cerebrospinal fluid expectoration; an unusual complication of ventriculo peritoneal shunting; a case report

Nelson Pires Ferreira^I; Decio Martins Costa Jr.^II; José A. M. Flores^III

^INeurocirurgião

^IIPediatra

^IIIRadiologista

RESUMO

É descrito o caso de uma paciente submetida a derivação ventrículo-peritoneal em que foi observada expectoração de líquido cefalorraqueano, como complicação.

SUMMARY

A child, who had undergone ventriculoperitoneal shunting, presented with repeated episodes of pneumonia and expectoration of CSF. Chest x-ray demonstrated the presence of the shunt catheter in the base of the left lung. In the present case the distal end of the catheter perfored the diaphragm, entering the thoracic cavity through the pleura and penetrating the pulmonary parenchyma. CSF then flowed freely into the alveoli and bronchi and became expectorated during repeated bousts of coughing associated with pneumonia. This respiratory complication disappeared after the removal of the catheter.

We theorize that the penetration of the catheter into the thoracic cavity was secundary to its displacement from the iliac fossa to the left infradiaphragmatic space between the spleen and the diaphragm where the intra-abdominal pressure is lowest. The respiratory movements and the hypertension inside the abdomen created a constant friction of the catheter against the diaphragm which was finally perforated, permitting the passage of the peritoneal end of the shunting device into the thoracic cavity and secundary penetration of the lung.

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Instituto de Neurocirurgia - Pavilhão São José - Praça Dom Feliciano - 90000 Porto Alegre, RS - Brasil.

1. ADELOYE, A. - Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. J. Neurosurg. 38:758, 1973.
2. ALMEIDA, G. M. & PEREIRA, W. C. - Derivação ventriculoperitoneal com válvula no tratamento da hidrocefalia do lactente. Arq. Neuro-Psiquiat. (São Paulo) 27:308, 1969.
3. COOPER, J. R. - Migration of ventriculoperitoneal shunt into the chest J. Neurosurg. 48:146, 1978.
4. DE SOUSA, A. L. & WORTH, R. M. - Extrusion of peritoneal catheter through abdominal incision: report of a rare complication of ventriculoperitoneal shunt. Neurosurgery 5:504, 1979.
5. EISENBERG, H. M.; DAVSON, R. I. & SHILLITO Jr., J. - Lumboperitoneal shunts. J. Neurosurg 35:427, 1971.
6. FACURE, J. J. - Derivação ventriculoperitoneal com válvula no tratamento da da hidrocefalia infantil; contribuição ao estudo do seu valor. Tese, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, 1971.
7. FERREIRA, N. P. & TORRES, M. C. R. - Derivação ventriculoperitoneal no tratamento do hidrocéfalo. R. Med. HED (Porto Alevre) 2:207, 1973.
8. FISCHER, E. G. & SHILLITO Jr., J. - Large abdominal cysts: a complication of peritoneal shunts; three cases report. J. Neurosurg. 31:441, 1969.
9. GIUFFRE, R. & Di LORENZO, N. - Two anusual complications of ventriculoperitoneal shunt in the same infant. Surg. Neurol. 3:23, 1975.
10. KEEN, P. K. & WEITZNER, S. - Inflamatory pseudotumor of mesentery: a complication of ventriculoperitoneal shunt; case report. J. Neurosurg. 38:371, 1973.
11. KEUCHER, T. R. & MEALEY Jr., J. - Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantil hydrocephalus. J. Neurosurg. 50:1q9, 1979.
12. MOZINGO, J. R. & CAUTHEN, J. C. - Vaginal perforation by a Raimondi peritoneal catheter in an adult. Surg. Neurol. 2:195, 1974.
13. PATEL, C. D. & MATLOUB, H. - Vaginal perforation as a complication of ventriculoperitoneal shunt; case report. J. Neurosurg. 38:761, 1973.
14. RAIMONDI, A. J.; ROBINSON, J. S. & KUWAMURA, K. - Complications of ientriculo-peritoneal shunting and a critical comparison af the three-piece and one-piece systems. Child's Brain 3:321, 1977.
15. SAKODA, T. H.; MAXWELL, J. A. & BRACKETT, C.E. - Intestinal volvulus secondary to a ventriculoperitoneal shunt: case report. J. Neurosurg. 35:95, 1971.
16. SANDERS, R. G. - Radiological and radioisotopic diagnosis of perihepatic abscess. C. R. C. Crit. Rev. Radiol. Med. 5:165, 1974

Datas de Publicação

Publicação nesta coleção
23 Ago 2012
Data do Fascículo
Dez 1980

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[1] 1. ADELOYE, A. - Spontaneous extrusion of the abdominal tube through the umbilicus complicating peritoneal shunt for hydrocephalus. J. Neurosurg. 38:758, 1973.

[2] 2. ALMEIDA, G. M. & PEREIRA, W. C. - Derivação ventriculoperitoneal com válvula no tratamento da hidrocefalia do lactente. Arq. Neuro-Psiquiat. (São Paulo) 27:308, 1969.

[3] 3. COOPER, J. R. - Migration of ventriculoperitoneal shunt into the chest J. Neurosurg. 48:146, 1978.

[4] 4. DE SOUSA, A. L. & WORTH, R. M. - Extrusion of peritoneal catheter through abdominal incision: report of a rare complication of ventriculoperitoneal shunt. Neurosurgery 5:504, 1979.

[5] 5. EISENBERG, H. M.; DAVSON, R. I. & SHILLITO Jr., J. - Lumboperitoneal shunts. J. Neurosurg 35:427, 1971.

[6] 6. FACURE, J. J. - Derivação ventriculoperitoneal com válvula no tratamento da da hidrocefalia infantil; contribuição ao estudo do seu valor. Tese, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Campinas, 1971.

[7] 7. FERREIRA, N. P. & TORRES, M. C. R. - Derivação ventriculoperitoneal no tratamento do hidrocéfalo. R. Med. HED (Porto Alevre) 2:207, 1973.

[8] 8. FISCHER, E. G. & SHILLITO Jr., J. - Large abdominal cysts: a complication of peritoneal shunts; three cases report. J. Neurosurg. 31:441, 1969.

[9] 9. GIUFFRE, R. & Di LORENZO, N. - Two anusual complications of ventriculoperitoneal shunt in the same infant. Surg. Neurol. 3:23, 1975.

[10] 10. KEEN, P. K. & WEITZNER, S. - Inflamatory pseudotumor of mesentery: a complication of ventriculoperitoneal shunt; case report. J. Neurosurg. 38:371, 1973.

[11] 11. KEUCHER, T. R. & MEALEY Jr., J. - Long-term results after ventriculoatrial and ventriculoperitoneal shunting for infantil hydrocephalus. J. Neurosurg. 50:1q9, 1979.

[12] 12. MOZINGO, J. R. & CAUTHEN, J. C. - Vaginal perforation by a Raimondi peritoneal catheter in an adult. Surg. Neurol. 2:195, 1974.

[13] 13. PATEL, C. D. & MATLOUB, H. - Vaginal perforation as a complication of ventriculoperitoneal shunt; case report. J. Neurosurg. 38:761, 1973.

[14] 14. RAIMONDI, A. J.; ROBINSON, J. S. & KUWAMURA, K. - Complications of ientriculo-peritoneal shunting and a critical comparison af the three-piece and one-piece systems. Child's Brain 3:321, 1977.

[15] 15. SAKODA, T. H.; MAXWELL, J. A. & BRACKETT, C.E. - Intestinal volvulus secondary to a ventriculoperitoneal shunt: case report. J. Neurosurg. 35:95, 1971.

[16] 16. SANDERS, R. G. - Radiological and radioisotopic diagnosis of perihepatic abscess. C. R. C. Crit. Rev. Radiol. Med. 5:165, 1974