Bladder perforation by ventriculoperitoneal shunt

Abstract

Based on this single experience and a literature review, the authors classified the clinical signs and symptoms of bladder perforation by the ventriculoperitoneal shunt catheter. Finally, the authors propose a more conservative approach for this rare complication.

Extrusion of peritoneal end of ventriculoperitoneal shunt through urethra in an infant: A rare complication

“…In the index case, there were no obstructive symptoms or vesical calculi. It can come out to be visible externally through urethra, which has been reported in 12 patients previously [7][8][9][10][11][12][13][14][15][16][17][18]. This can be asymptomatic as in our case or it can present with urinary symptoms like urinary incontinence [19] or hematuria [20].…”

Bladder Perforation of a Ventriculoperitoneal Shunt Catheter: Case Report and Literature Review

“…So, this complication should be considered in this patient. Regarding diagnosis, it is recommended at least to perform an abdominal ultrasound [2] as we did in our case. Prasad et al [7] suggested that this perforation is caused by a series of events such as catheter fixation, penetration and eventual perforation of the bladder wall, with subsequent exteriorization through the urethra [7,8].…”

“…This complication is much more frequent in the pediatric age (67.9%) and there seems to be no gender association or any link with the etiology of hydrocephalus (Table 1). Some authors argue that bladder perforation may be related to a bigger bladder volume [2] as they observed this complication in 8 patients with an augmented bladder (28.6%). Regarding the clinical presentation, 20 patients (71.4%) presented catheter exteriorization through the urethra, approximately half of them being asymptomatic, as occurred in our case.…”

“…For this reason, we recommend the culture of both, the CSF and the removed system, as well as other authors do [8]. Some authors recommend two treatment strategies [2]. In case of externalization of the catheter through the urethra, a suprapubic medial laparotomy is recommended to access the abdominal cavity, cut the catheter near to the bladder wall, repair the bladder wall and relocate the intraperitoneal end.…”

“…This complication can have different clinical manifestations. Being a rare pathology, there is no consensus on the treatment, however, most authors recommend replacing the system and antimicrobial therapy [2]. We describe another the case and a review of the literature.…”