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