Budd-Chiari syndrome, ascites and shunt malfunction due to hyperosmolar hypernatremia in operated pediatric craniopharyngiomas: a red herring.

INTRODUCTION: 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. CASES: 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. DISCUSSION: The role of hypernatremia, serum hyperosmolality, and Vasopressin analogs in the pathology are discussed along with imaging and treatment.