Ventriculoperitoneal shunt

After IV administration, vancomycin diffuses into serous cavities and across inflamed but not normal meninges. It can be used in the treatment of meningitis with susceptible organisms. It is also given via ventriculoatrial or ventriculoperitoneal shunts when these become infected. 

Identification of patients with adult-onset hydrocephalus that will respond to a ventriculoperitoneal shunt is challenging. Criteria have been established, but the rate of response remains low (Boon et al., 2000 Kahlon et al., 2005 Marmarou et al.,... 

A 9-year-old child with a repaired myelomeningocele and congenital hydrocephalus who had undergone four previous shunt revisions in the past had two episodes of anaphylaxis during insertion of the ventriculoperitoneal shunt. The shunt tubing had been soaked in a solution of bacitracin 2500 U/ml. A skin prick test was positive for bacitracin. 

Goldblum RM, PeUey RP, O DoneU AA, Pyron D, Heggers JP. Antibodies to silicone elastomers and reactions to ventriculoperitoneal shunts. Lancet 1992 340(8818) 510-13. 

Primary peritonitis in adults occurs most commonly in association with alcoholic cirrhosis, especially in its end stage, or with ascites caused by postnecrotic cirrhosis, chronic active hepatitis, acute viral hepatitis, congestive heart failure, malignancy, systemic lupus erythematosus, or nephritic syndrome. It also may result from the use of a peritoneal catheter for dialysis or central nervous system ventriculoperitoneal shunting for hydrocephalus. Rarely, primary peritonitis occurs without apparent underlying disease. 

Fig. 11.17. Right grade III-IVVURin 8-year-old patient with neurogenic bladder and ventriculoperitoneal shunt...

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