Patient

A male patient, 1 years old was consulted from pediatric

emergency unit to surgical unit with:

Chief complaint :
Decrease of consciousness 10 days before admission
Present Illness History
• Decrease of consciousness 11 days before admission
• History of headache since 2 month ago
• Seizure since 10 days ago, frequency 1 x/ day, seizures
stop after being given anticonvulsant drug
• He was not conscious after seizure
• Vomitus (+)
• Fever (+) since 20 days ago
• History of trauma (+) dropped from bed within 1 me-
ter.
• History of tuberculosis (-)
• No other past illness
Physical Examination
•General Appereance : Moderatelly Illness
•Consiousness : GCS
•Blood pressure : 90/50 mmHg
•Heart Rate : 120x/Minutes
•Respiration Rate : 30x/Minutes
•Temperature : 37o C

Eyes : pupil isocor 3mm/3mm, light reflect (+/+)

Conjungtive was not anemic
Thorax & Abdomen was normal
Locally state :
Head and neck region :
Ins : Wound (-), Hematome (-)
Pal : neck stiffness (+), Brudzinski 1 (+)
Working diagnose:
•Decrease of conciousness due to susp hydrocephalus
•Susp. Meningitis

Laboratorium :
Hb : 8,2 gr/dl Ur/Cr : 17/0,4
Wbc : 1.120/ mm3 Na/K/Cl : 128/4,3/91
Ht : 26 %
Platelet: 425.000/mm3
Brain CT-Scan
Diagnose:
• Decrease of conciousness due to communican hydro-
cephalus due to susp meningitis G91.9 Hydrocephalus

Patien was preapered :

• Informed consent
• IVFD
• NPO
• Antibiotic
• Consult to pediatric and covid team -> covid 19 (-)
• Consult to anesthesiologist
Plan
VP shunt
 Operative Report
• Supine position under general anesthesia
• Desinfect of the operative field
• Performed golf stick incision 8 cm
• Open layer by layer.
• Performed ventriculostomy ventricular shunt 6cm by
burrhole
• The CSF was clear.
• Incision right paraumbilical 5 cm. Open layer by layer.
• Tunneling passer from distal to proximal
• Connect the pump.
• Insert to peritoneal cavity about 25 cm
• Close operative wound layer by layer