Complicaciones inusuales de las derivaciones ventrículoperitoneales. A propósito de 2 casos pediátricos / Unusual complications of ventriculoperitoneal shunts. About 2 pediatric cases

Introducción: Durante el seguimiento de los pacientes con derivación ventrículoperitoneal (DVP) para el tratamiento de la hidrocefalia se pueden presentar complicaciones habituales relacionadas a la derivación, tales como infecciones u obstrucción/ruptura del sistema derivativo. Sin embargo, raramente se pueden observar complicaciones más raras y graves que pueden afectan a órganos como el corazón y el pulmón. Pacientes y métodos: Presentamos 2 pacientes con raras complicaciones relacionadas a la DVP. El primero, un paciente de 10 años, que después de 7 años de la implantación de una DVP presentó episodios de neumonía recurrente secundaria a la migración intrapulmonar del catéter distal. El segundo caso, un paciente de 3 años, que 5 meses posteriores a la colocación de una DVP presentó síntomas de hipertensión endocraneana secundarios a migración intracardíaca del catéter distal. Conclusión: La migración intrapulmonar e intracardíaca del catéter distal son complicaciones extremadamente raras, pero que pueden producir morbilidad importante. Los pacientes con derivación ventrículoperitoneal deben ser controlados de forma rutinaria de por vida, con la finalidad de evitar comorbilidades asociadas a sus complicaciones.

Introduction: during the follow-up of patients with ventriculoperitoneal (VP) shunts for the treatment of hydrocephalus, common complications may occur, such as infections or obstruction/rupture of the shunt system. However, more rare and serious complications that affect organs such as the heart and lungs can be observed Patients and methods: we present 2 patients with rare complications related to VP shunts. The first, a 10-year-old patient, who 7 years after implantation of a VP shunt, presented episodes of recurrent pneumonia secondary to intrapulmonary migration of the distal catheter. The second case, a 3-year-old patient, who 5 months after the placement of a VP shunt, presented with symptoms of intracranial hypertension secondary to intracardiac migration of the distal catheter. Conclusion: intrapulmonary and intracardiac migration of the distal catheter are extremely rare complications, but they can cause significant morbidity. Patients with ventriculoperitoneal shunts should be routinely monitored for life by neurosurgeons, in order to avoid comorbidities associated with potential complications.

Early Intrathoracic Migration of K-wire Used for Fixation of Proximal Humerus Fracture / 대한정형외과학회잡지

We report a case of early intrathoracic migration of Kirshner wire (K-wire), which had been-used for fixation of proximal humerus fracture. A 74 year-old-woman visited the emergency room due to sudden onset of dyspnea. A chest x-ray and CT scan taken at the emergency room demonstrated 3 K-wires that had been applied to the proximal humerus fracture, 1 K-wire in the anterior chest wall, and mild pneumothorax of the right lung. An emergency removal of K-wire using thoracoscopy was performed and a chest tube was inserted for the treatment of pneumothorax during thoracic surgery. We removed residual 3 K-wires from the right proximal humerus and fixed right proximal humerus fracture by open reduction and internal fixation using a proximal humerus locking plate. We think that if a proximal humerus fracture is fixed using smooth K-wire, patients require close follow-up with the use of x-ray until the K-wire has been removed, in addition, it is very important to take steps to prevent K-wire migration.