Disseminated intravascular coagulation associated with ventriculoperitoneal shunt surgery

2010 ◽  
Vol 5 (3) ◽  
pp. 306-309 ◽  
Author(s):  
James L. Frazier ◽  
G. Steven Bova ◽  
Kathryn Jockovic ◽  
Elizabeth A. Hunt ◽  
Benjamin Lee ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Cardiopulmonary Arrest ◽  
Shunt Revision ◽  
Neurosurgical Procedures ◽  
Laboratory Studies ◽  
Excessive Bleeding ◽  
Head Ct ◽  
Intravascular Coagulation ◽  
History Of ◽  
Complication Of Surgery

Disseminated intravascular coagulation (DIC) as a complication of surgery for ventriculoperitoneal (VP) shunts is extremely rare, and only one case has been documented in the literature. The authors present the case of a 9-year-old girl with shunted hydrocephalus who presented with a 3-day history of headaches and vomiting. A head CT showed enlarged ventricles compared with baseline. An emergent VP shunt revision was performed, during which an obstructed proximal catheter was found. Immediately after extubation, the patient became apneic and progressed to cardiopulmonary arrest. A breathing tube was reinserted followed by resuscitation attempts that led to extracorporeal membrane oxygenation. Soon after reintubation, bloody drainage was noted in the endotracheal tube, and subsequent laboratory studies were consistent with DIC. The patient died on postoperative Day 1, and autopsy findings confirmed DIC. Note that DIC is a recognized complication of trauma, particularly with brain injury, but it is rare with neurosurgical procedures. Disseminated intravascular coagulation should be considered if excessive bleeding occurs after any brain insult.

Disseminated intravascular coagulation as a complication of ventricular catheter placement

1981 ◽  
Vol 54 (2) ◽  
pp. 264-267 ◽  
Author(s):  
Susan Shurin ◽  
Harold Rekate
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Early Recognition ◽  
Bleeding Complications ◽  
Ventricular Catheter ◽  
Neurosurgical Procedures ◽  
High Concentration ◽  
Clotting Factors ◽  
Excessive Bleeding ◽  
Content Type ◽  
Intravascular Coagulation

✓ A child who developed generalized bleeding immediately after placement of a ventriculoperitoneal shunt was found to have evidence of disseminated intravascular coagulation (DIC). Infusion of fresh frozen plasma was followed promptly by improvement in laboratory values and cessation of bleeding. Complications of the acute bleeding episode included intraventricular hemorrhage, loss of 50% of the red cell volume into subcutaneous tissues, and transient peritoneal irritation. Defibrination syndrome (that is, DIC) due to release of tissue thromboplastin is a recognized complication of trauma, particularly with brain injury. Defibrination can be induced in experimental systems with administration of very small amounts of thromboplastin, which is present in high concentration in brain tissue. This has not been described previously with minor neurosurgical procedures. The diagnosis of DIC should be considered if excessive bleeding occurs after any brain insult, since early recognition and restoration of normal hemostasis by replacement of clotting factors should prevent major complications due to ongoing hemorrhage.

scholarly journals Disseminated Intravascular Coagulation and Malignancy: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Sumit Sohal ◽  
Akhilesh Thakur ◽  
Aleena Zia ◽  
Mina Sous ◽  
Daniela Trelles
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Cardiac Arrest ◽  
Disseminated Intravascular Coagulation ◽  
Limb Ischemia ◽  
Symptomatic Treatment ◽  
Malignant Cells ◽  
Intravascular Coagulation ◽  
Fluid Analysis ◽  
History Of

Disseminated Intravascular Coagulation (DIC) is a disorder of coagulation which is commonly seen as a complication of infections, traumas, obstetric diseases, and cancers especially hematological and rarely solid cancers. DIC may rarely be the presenting feature of an undiagnosed malignancy. It may present in the form of different phenotypes which makes its diagnosis difficult and leads to high mortality. The treatment comprises supportive, symptomatic treatment and removal of the underlying source. Here, we present a patient with history of being on warfarin for atrial fibrillation and other comorbidities who presented with elevated INR of 6.3 and increasing dyspnea on exertion. Over the course of her stay, her platelet counts started dropping with a concurrent decrease in fibrinogen levels. She eventually developed pulmonary embolism, followed by stroke and limb ischemia, which was indicative of the thrombotic phenotype of DIC. Her pleural fluid analysis showed huge burden of malignant cells in glandular pattern suggestive of adenocarcinoma and was started on heparin drip. However, the patient had cardiac arrest and expired on the same day of diagnosis.

scholarly journals Disseminated intravascular coagulation in an under-recognised zoonotic infection

2017 ◽  
Vol 16 (3) ◽  
pp. 138-141
Author(s):  
Sarah Lawrence ◽  
◽  
Andrew Claxton ◽  
Mark Holland ◽  
Jack Hodd ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Disseminated Intravascular Coagulation ◽  
Platelet Transfusion ◽  
Purpura Fulminans ◽  
Blood Cultures ◽  
Organ Support ◽  
Zoonotic Infection ◽  
Intravascular Coagulation ◽  
Prompt Treatment ◽  
History Of

A 51 year old man presented with severe sepsis, disseminated intravascular coagulation (DIC) and multiorgan dysfunction after a 24 hour history of diarrhoea and malaise. Despite fluid resuscitation and receiving a platelet transfusion, freshfrozen plasma and intravenous broad-spectrum antibiotics, he remained anuric with a worsening metabolic acidosis. He was transferred to critical care for organ support including renal replacement therapy. He subsequently developed purpura fulminans. Blood cultures were positive for Captocytophaga carnimorsis, a gram-negative canine zoonosis that is an underdiagnosed cause of severe sepsis, for which DIC at presentation is characteristic. Treatment is with penicillins and fluoroquinolones. Identification of risk factors for unusual organisms and recognition of DIC allowing prompt treatment is critical for the acute physician.

Thoracoscopic-Assisted Ventriculo-Azygous Shunt Placement for the Treatment of Hydrocephalus

2015 ◽  
Vol 11 (4) ◽  
pp. 491-494 ◽  
Author(s):  
Jonathan Pace ◽  
Gabriel A Smith ◽  
Andrea Pannunzio ◽  
Brian D. Rothstein ◽  
Alan Markowitz ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Shunt Revision ◽  
Neurosurgical Procedures ◽  
Shortness Of Breath ◽  
Azygous Vein ◽  
Shunt Placement ◽  
Cerebrospinal Fluid Diversion ◽  
History Of ◽  
Shunt Dependence

Abstract BACKGROUND Cerebrospinal fluid diversion is one of the most frequent neurosurgical procedures across the world and can be challenging in select patients who fail standard distal drainage sites. OBJECTIVE To present the case of a woman after failing peritoneal, pleural, and atrial distal drainage sites who underwent a thoracoscopic-assisted ventriculo-azygous vein shunt placement. METHODS A 32-year-old woman presented to our hospital with long-standing history of hydrocephalus and shunt dependence. She had failed peritoneal and atrial shunts secondary to infection, scarring, and clot formation. At presentation, she had a pleural shunt in place and developed a large pleural effusion with shortness of breath. RESULTS She was taken to the operating room where a thoracoscopic-assisted ventriculo-azygous vein shunt was placed through a mini-thoracotomy. Postoperatively, she has not required a shunt revision in >2 years of follow-up. CONCLUSION When other distal sites fail, our case report illustrates a novel surgical technique capable of being performed through a multidisciplinary approach.

scholarly journals Priapism as the Presenting Complaint in Fatal Group A Streptococcal Induced Disseminated Intravascular Coagulation

CJEM ◽  
2016 ◽  
Vol 20 (S2) ◽  
pp. S6-S8
Author(s):  
Richard J. Baverstock ◽  
Colleen Carey
Keyword(s):  
Emergency Department ◽  
Sore Throat ◽  
Mental Status ◽  
Disseminated Intravascular Coagulation ◽  
Cardiopulmonary Arrest ◽  
Severe Headache ◽  
Intravascular Coagulation ◽  
Group A ◽  
Septic Thrombosis

AbstractA 60-year-old male presented to an emergency department (ED) with priapism following a sore throat illness. He did not have typical findings of sepsis. The patient then developed severe headache, mental status changes, and hypertension, then suffered a cardiopulmonary arrest. Autopsy showed group A streptococcal (GAS) sepsis, disseminated intravascular coagulation (DIC), and a septic thrombosis to the penile vein. This is the first known case of priapism being the presenting symptom of DIC.

Disseminated Intravascular Coagulation With Trauma: Treatment With Exchange Transfusion

PEDIATRICS ◽  
1979 ◽  
Vol 63 (2) ◽  
pp. 337-339
Author(s):  
Ashok P. Sarnaik ◽  
Kenneth D. Stringer ◽  
Patrick F. Jewell ◽  
Sharada A. Sarnaik ◽  
Y. Ravindranath
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Exchange Transfusion ◽  
Hypovolemic Shock ◽  
Volume Overload ◽  
Trauma Treatment ◽  
Severe Bleeding ◽  
Clotting Factors ◽  
Traumatic Injuries ◽  
Intravascular Coagulation ◽  
History Of

Disseminated intravascular coagulation (DIC) may complicate hypovolemic shock secondary to trauma.1 Treatment with heparin in such cases is contraindicated because of the risk of bleeding at the site of trauma. Replacement therapy with clotting factors and platelets alone may be inadequate2 or result in volume overload in the presence of compromised renal function. We describe here a patient with multiple intraabdominal traumatic injuries whose severe bleeding diathesis secondary to DIC was successfully treated with exchange transfusion. CASE REPORT A 10-month-old black boy weighing 10 kg was brought to Children's Hospital of Michigan, Detroit with a history of grunting for three hours and "not feeling well" for three weeks.

scholarly journals Diagnosis and management of disseminated intravascular coagulation: the role of heparin therapy

Blood ◽  
1982 ◽  
Vol 60 (2) ◽  
pp. 284-287 ◽  
Author(s):  
DI Feinstein
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Purpura Fulminans ◽  
Underlying Disease ◽  
Additional Treatment ◽  
Neoplastic Disease ◽  
Excessive Bleeding ◽  
Intravascular Coagulation ◽  
At Iii ◽  
Hemostatic Factors

Abstract Disseminated intravascular coagulation (DIC) is caused by a variety of underlying disorders, and criteria for diagnosis are not well defined. However, the most helpful are a low platelet count, positive plasma protamine test, and fibrinogen and fibrin degradation product levels viewed in the context of the patient's underlying disease. The cornerstone of therapy is prompt treatment of the underlying disease and elimination of the trigger mechanism. Additional treatment must be individualized, and generalizations are difficult to make. However, if the patient has low hemostatic factors and is actively bleeding or requires an invasive procedure, then replacement with the appropriate hemostatic factors should be tried. Heparin is indicated in patients with purpura fulminans and venous thromboembolism, but there is little evidence that heparin reverses organ dysfunction associated with DIC. In addition, heparin is also probably indicated in patients with retained dead fetus and hypofibrinogenemia prior to induction of labor, excessive bleeding associated with a giant hemangioma, and neoplastic disease, particularly promyelocytic leukemia. Although the use of heparin in acute forms of DIC remains controversial, the majority of studies suggest that it is not helpful. The role of antithrombin III (AT-III) concentrates is unknown, but they theoretically may be helpful when DIC is associated with very low AT-III levels, as is seen in liver disease.

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