// // // //

Case 163: Hardware at laparoscopy

You are performing a laparoscopic appendicectomy. Your intern asks what that white tubing is.

1. What is it?

It is a ventriculo-peritoneal shunt used to treat hydrocephalus.

The problem with this hardware is not its identification, but the diagnostic confusion it can make.

These patients can present with abdominal pain which is difficult to discern. The pain could arise from a primarily infected shunt or could also arise from a primary intraabdominal problem (as in this case)

Methods to differentiate include drawing off some CSF from the reservoir port (performed by the neurosurgeons, if this shows pure growth of a characteristic skin organism then it is more likely a shunt problem) or performing a diagnostic laparoscopy.

PubMed