Unusual complications of Ventriculo Peritoneal Shunt: 15 years experience.

Ventriculo-Peritoneal shunt is the most commonly performed surgery for hydrocephalus, universally Many complications are reported, of which the shunt malfunction and infection are most commonly encountered. These common complications can be minimized, by precautions like– senior surgeons operating shunt cases, as the first case in the operation, with minimal personnel in the operation and thoroughly scrubbing the part for minimum five minutes. However, in few cases, – even in the experienced hands and with all precautions, some rare complications like extrusion of the lower end through anus, vagina, into scrotum were described. In our experience of over 15 years, wide range of complications was seen apart from malfunction and infection. Exposure of the part of shunt system, with excoriation of overlying skin, peritubal leaks, disconnection of shunt system with CSF leaking out, loculation in between the loops of bowel/ omentum, extrusion of the lower end through anus etc. were encountered and probable factors for these unusual complications were discussed.

Open skull fractures with brain fungation: Simple principles for good outcome Our experience.

The incidence of head injuries is increasing worldwide. The associated skull fractures are also increasing with rise in vehicular traffic. In the present study, a total of 214 cases of head injuries which were admitted into a Rangaraya Medical College Hospital from the time period of 2 years, were taken for the study. Out of them 124 cases presented with skull fractures ranging from simple linear to stellate, depressed, comminuted, compound and compound comminuted depressed fractures. Some fractures were extending to the base of skull and some to the vault and some were associated with facio-maxillary injuries. 17 cases out of the 124 open skull fractures, presented with cerebro- spinal fluid leak and brain matter seen directly herniating through the wound. The wounds in all the cases were contaminated, with many cases harboring hair, sand particles etc. Majority of them were secondary to road traffic accidents, but assaults and some directly hitting injuries under the influence of alcohol were also included. As there was an evident CSF leak and brain matter already present in the wounds, all the cases were taken up for emergency surgery. In spite of the grossly contaminated wounds, thorough wound debridement and closure of defects and duraplasty wherever feasible, resulted in very good improvement in all the cases. No mortality or procedure related morbidity was observed in any of these cases.