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  IN THIS Article
 ::  Abstract
 ::  Introduction
 ::  Case report
 ::  Discussion
 ::  Acknowledgments
 ::  References

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CASE REPORTS
Year : 1992  |  Volume : 38  |  Issue : 2  |  Page : 87

Radionuclide assessment of peritoneovenous shunt patency.


Dept of Nuclear Medicine, Seth GS Medical College and KEM Hospital, Parel, Bombay.,

Correspondence Address:
S Shikare
Dept of Nuclear Medicine, Seth GS Medical College and KEM Hospital, Parel, Bombay.

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PMID: 0001432839

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 :: Abstract 

Denver shunt patency can be easily assessed by sequential scintigraphy with a Gamma camera after an intraperitoneal injection of 99mTc sulphur colloid. If the shunt is patent, the tracer will be seen throughout the shunt upto it's opening into the right atrium. The following case report illustrates the application and usefulness of this procedure.


Keywords: Adult, Case Report, Female, Human, Liver Cirrhosis, complications,radionuclide imaging,surgery,Peritoneovenous Shunt, standards,Vascular Patency,


How to cite this article:
Shikare S, Nagral A, Supe A N, Tilve G H. Radionuclide assessment of peritoneovenous shunt patency. J Postgrad Med 1992;38:87

How to cite this URL:
Shikare S, Nagral A, Supe A N, Tilve G H. Radionuclide assessment of peritoneovenous shunt patency. J Postgrad Med [serial online] 1992 [cited 2014 Aug 31];38:87. Available from: http://www.jpgmonline.com/text.asp?1992/38/2/87/708





  ::   Introduction Top


Intractable ascites can be effectively treated by insertion of the peritoneovenous shunt designed by Leveen et al[1]. During inspiration when the intraperitoneal pressure rises 3-5cm above the intrathoracic venous pressure, ascitic fluid flows into the venous system. A unidirectional valve prevents backflow of the venous blood and patency of the shunt is maintained. However, in about 5-8% of patients, the valve malfunctions, resulting in back flow and thrombosis of the shunt. If this complication is recognised promptly, the shunt can be revised, with considerable benefit to the patient. Shunt patency can be assessed by sequential scintigraphy with a gamma camera after intraperitoneal injection of a suitable radionuclide.


  ::   Case report Top


A 28-year-old woman with cirrhosis and intractable ascites underwent the placement of a Denver shunt. Postoperative ly, the patient's ascites decreased. To evaluate shunt patency, a radionuclide study was performed after the intraperitoneal injection of 5 mci 99mTc sulphur colloid. The patient was instructed to slowly roll around to disperse the radionuelide throughout the peritonea] space and then asked to take deep breaths regularly. Using a large field gamma scintillation camera equipped with 140 kav parallel hole collimator, sequential 30 seconds scintiphotos were taken upto 10 minutes in the anterior projection. It showed normal flow of radiotracer from peritoneal cavity into the right atrium through the shunt suggesting a patent Denver shunt.


  ::   Discussion Top


Denver shunt patency may be assessed by several techniques including Doppler flow meter, radiography after direct injection of contrast medium into the venous tubing, and nuclear imaging after intraperitoneal injection of radiotracer. Results of the Doppler flow meter are not always conclusive and radio-opacity of the tubing precludes effective use of roentgenography [2]. Nuclear imaging offers a safe, simple method for assessing shunt patency and is inexpensive and easy to perform [1],[3]. In the present case report, we have demonstrated the normal functioning peritoneovenous shunt, thus highlighting the utility of radionuclide assessment of peritoneovenous shunt patency.


  ::   Acknowledgments Top


We acknowledge the Dean, Seth GS Medical College and King Edward Memorial Hospital for allowing us to publish this case report.

 
 :: References Top

1. Leveen HH, Christoudias G, Moon IP. Peritoneovenous shunt forascites. Ann Surg 1974; 180:580-581.  Back to cited text no. 1    
2.Leveen HH. Editorial comment. Arch Surg 1976; 111:303-304.  Back to cited text no. 2    
3.Krichner N, Hart U. Radionuclide assessment of Leveen shunt patency. Ann Surg 1977; 198:145-146.   Back to cited text no. 3    



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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
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