Budd-Chiari syndrome, ascites and shunt malfunction due to hyperosmolar hypernatremia in operated pediatric craniopharyngiomas: a red herring.
BACKGROUND
Postoperative management of sellar and suprasellar lesions in children involves regular evaluation of fluid, electrolyte, and neuroendocrine parameters. On discharge, maintenance of water homeostasis is difficult especially among those with access to only basic primary health care. Complications of a chronic hypernatremic state can lead to severe morbidity and mortality.


METHODS
The authors present two cases of craniopharyngioma who developed inferior vena cava thrombosis, Budd-Chiari syndrome, and shunt malfunction postoperatively. Factors which predispose to a hypercoagulable state are evaluated along with measures undertaken to identify and treat the cause of ascites and shunt malfunction.


CONCLUSIONS
The role of hypernatremia, serum hyperosmolality, and Vasopressin analogs in the pathology are discussed along with imaging and treatment.
Furtado
Sunil V
SV
Department of Neurosurgery, Sri Satya Sai Institute of Higher Medical Sciences, EPIP Area, Whitefield, Bangalore, 560066, India. sunilvf@gmail.com
Dash
P K
PK
Reddy
K
K
Hegde
A S
AS
D001201:Ascites / Q000209:etiology / Q000601:surgery; D006502:Budd-Chiari Syndrome / Q000209:etiology* / Q000601:surgery; D002675:Child, Preschool; D003397:Craniopharyngioma / Q000150:complications* / Q000601:surgery; D004868:Equipment Failure; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010911:Pituitary Neoplasms / Q000150:complications* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology; D020246:Venous Thrombosis / Q000209:etiology; D017287:Ventriculoperitoneal Shunt