Patient presentation
We present the case of a 36-year-old male who suffered multiple trauma
after a falling from 4 meters height. The patient had traumatic brain
injury and the CT scan showed a subdural hematoma in both hemispheres.
Thus the patient underwent decompressing craniotomy.
After a month, the patient developed post traumatic hydrocephalus and a
VP shunt was put into left lateral ventricle and a cranioplasty was done
simultaneously.
The patient was followed and 6 months later, the VPS placement surgery
was redone after a shunt malfunction was diagnosed.
a month later, the patient showed up with a history of worsening
headaches and was scheduled for surgery with a diagnosis of recurrent
shunt malfunction. The proximal part of the VPS was removed from the
left ventricle but the distal part couldn’t be removed despite trying
and eventually was left in place. Afterwards, another VP Shunt was
placed into right lateral ventricle.
About a year later, the patient showed up to ER with complaint of a
swelling sized 3cm*4cm in left supraclavicular region (figure 1).
Knowing about the patient previous history and the history of the VPS, a
pus collection was suspected. the patient had no other symptoms and no
history of fever or pain. The patient was scheduled for an ultrasound
study and surprisingly a collection of air was confirmed. The patient
was thoroughly examined and a yellowish tube, protruded from anus was
seen (figure 2).
Fig.1 Supraclavicular bulge containing air