I wrote about a patient who suffered from mesenteric panniculitis and had surgery on October 27th. I'm going to report his passage afterwards today. After his last operation on Oct.27th, the patient was getting better and his mental status showed remarkable improvement. I felt that he overcame the illness.
However, I found swelling of the wound on his abdomen today and I performed ultrasonography on his abdominal wall. To my regret, I found fluid collection in his abdominal wall just beneath the wound. I and my colleague neurosurgeon thought that the VP shunt tube had come out of the abdominal cavity and must lie in the abdominal wall. The cerebrospinal fluid (CSF) coming out through the VP shunt tube was surely the cause of the swelling. As we thought like this, we performed the operation again with use of a local anesthetic.
We were surprised to see the tip of the VP shunt tube. The tube didn't come out! It stayed in the abdominal cavity as we had set it in the previous operation. The CSF coming out of the tube formed the cyst in the abdominal cavity and wasn't absorbed by the peritoneal membrane. Overflowing CSF came out of the cyst and formed a fluid collection just under the wound.
After all, we fell into the same rut. Abnormal granulation was formed around the VP shunt tube and interfered with the drainage of the CSF. Although we prevented these granulations from causing intestinal obstruction this time, out of necessity we are performing external drainage to remove the extra CSF at present. We have to figure out the solution.
I know that mesenteric panniculitis is benign, never malignant. Nevertheless, it always bothers us.
Continued from :
http://kumo.typepad.jp/weblog/2006/10/vp-shunt-operat.html
(Vocabulary)
rut 車（輪）の跡、わだち
fall into the same rut 轍を踏む、前人と同じ失敗をする
(This blog service shows me how and from where visitors read my blog. It says about 10 people came here via search engines searching with the keyword "mesenteric panniculitis". All of them maybe want to solve these problems. If you are such doctors, email me! Not only surgeons but also physicians!)
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