Brief Answer:
Consultation

Detailed Answer:
Hi XXXX, thanks for asking from HCM.


I can understand your concern. It is so sad that your son had to undergo so many revisions of VP shunt. He is a very brave man.

The VP shunt is one of the EASIEST and MOST COMPLICATED surgery. However good VP shunt you choose, it can get blocked. As you mentioned, he had 14 revisions and so much scar on abdominal wall, the reason behind pain on left side abdomen could be

: Abdominal pseudocyst at shunt site - It can form due to CSF collection and reaction due to it. It can cause pain, fullness, decreased appetite, feeling of lump in abdomen.

It can be confirmed by palpation of abdomen and ultrasound of abdomen. It is treated by revision of shunt and surgical drainage of cyst.

: Intestinal obstruction - It occurs due to infected CSF causing adhesions between intestinal folds and thus obstruction. It manifests as pain abdomen, cramps, no passage of stools/gas, vomiting, no appetite and pain after eating food.

Confirmation is by palpation and listening hyperactive bowel sounds, CT abdomen. It is usually treated by conservative management, sometimes surgery and shunt revision.

: Peritonitis - It is due to infected CSF and manifests as severe persistent pain abdomen, rigid abdomen, vomiting, no intestinal movement, no appetite, severe pain after eating food.

Confirmation is by palpation of abdomen and CT abdomen. Treatment is by drainage of infected CSF, antibiotic therapy and revision of shunt.

Now you can suspect from above after matching your son symptoms. If still in doubt, try to pressure chamber of shunt. If it is compressible, it is functioning and if not, it means, shunt malfunction is the cause.

The neurosurgeon has already done shunt tap. Can you please provide the report of CSF and CSF pressure. What conclusion did he make after tapping?

Regarding revision of shunt, there are few options

: Abdomen - It is the most common and easy way to revise shunt. The surgeon will try to find raw or virigin area to give incision and safely place shunt. But in your son, he is having so much scar.

: Ventriculoatrial shunt - It means placing shunt tube in right side of heart. It is done through neck vein and usually helpful in patients of failed VP shunt. It is also associated with few cardiac complications, shunt blocked. You can discuss it with your doctor.

: Endoscopic third ventriculostomy - It means making a new CSF passage in brain to drain it. One endoscope is used to create an opening in third ventricle (CSF reservoir). It is good for "obstructed hydrocephalus cases".

If you need more information on any procedure, do let me know. I would be happy to help you.

Thanks. Take care.

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