The patient was operated for hydrocephalus at KHMC when she was 6 months age. 3 months ago got nausea and vomiting and right paresis, for what she was diagnosed as having the distal part of the VPS was not functioning, She was operated elsewhere 04-July-2021 with revision of the distal part of the shunt. She improved, then a collection of CSF was noticed in the under the scalp, which was noticed before the revision. Her condition deteriorated for what she came to the clinic 24-July for evaluation.

On examination, the patient is is alert and irritable and check of the shunt reservoir showed non-functioning of the distal part of the shunt. The patient before coming here performed CT-scan of the abdomen 23-July-2021 showing loops at the right side of the abdomen with buckling, which is mostly the cause of the non-function. It was decided to totally replace the shunt with PS Medical VPS medium pressure adult type. The shunt for unknown reasons was inserted from the left side. The reservoir is located very low nearly at the neck area. There are 2 separate abdominal incisions in the left side of the upper abdomen.

The old VPS removed and replaced with new PS Medical medium pressure adult type VPS. Check for functioning was OK! and plain abdominal X-ray  was showing the shunt inside the abdomen. She was sent to the ward.

Reconstruction using ORS Visual showing 2 suspected areas of the defects.

Too early now.

When VPS start to troubleshoot, it is preferable to replace the whole unit with new one. You cannot be sure where is the defect of defects are located.