Erosive Bladder Perforation as a Complication of Ventriculoperitoneal Shunt with Extrusion from the Urethral Meatus: Case Report and Literature Review

Abstract

Ventriculoperitoneal (VP) shunt surgery is the most common technique used in the treatment of hydrocephalus. Erosive bladder perforation is an extremely rare complication of VP shunt surgery. Only 2 cases of erosive bladder perforation by a peritoneal catheter have been reported in the English literature. The authors present the case of a 14-year-old male with a history of cerebral palsy, severe developmental delay and hydrocephalus who presented with VP shunt tubing protruding from his urethral meatus. The patient had no evidence of neurological change. The VP shunt had been last revised over 11 years prior to admission. Imaging demonstrated the VP shunt to be intact, but displaced inferiorly, with the ventricular catheter in the extracranial soft tissue of the neck and the peritoneal catheter passing into the abdomen, bladder, and out through the urethra. Shunt removal was achieved through a multidisciplinary approach, involving both neurosurgery and urology teams. The authors discuss other reported cases of perforation by a VP shunt, potential mechanisms, and considerations for management of this rare complication.

An Acute Complication of Ventriculoperitoneal Shunt with Bladder Perforation and Extrusion through the Urethra in a Newborn: Case Report and Review of the Literature

“…In our case this complication occurred only 1 day after the VPS implantation as an acute complication of this procedure. This complication has been more commonly reported in childhood [1,2,3,6,7,8,9,10,11,12,15,16,17,18] but it has also been described in adulthood [4,13,14,19]. Although this complication has not been reported in the neonatal period in the literature, our patient was a neonate.…”

“…This complication occurred in 35% (n = 8) of cases with augmented bladder [2,5,8,11,14], while the others (n = 15) had normal bladder [1,3,4,6,7,9,10,12,13,15,16,17,18,19]. Our case was one of neurogenic bladder.…”

“…The most common clinical presentation of this complication is urethral extrusion of the peritoneal catheter, as seen in our patient [2,3,4,7,11,12,13,15,16,17]. Hematuria [6,9,10,13,18,19], bladder calculus formation [6,10,18,19], urological symptoms such as urgency, frequency, dysuria, suprapubic or abdominal pain [1,8,10,18,19], neurological symptoms [11,16], intravesical knotting of catheter [12,17], fever [1,8], erythema involving the lower abdominal wall [1], increased serum creatinine [8], vomiting [8], shunt infection and malfunction [5,8], electrolyte imbalance[11], and extrusion of a VPS catheter through a Mitrofanoff appendicovesicostomy [14] have been reported in the literature as clinical presentations of this complication.…”

“…We found only 23 cases of VPS complication with bladder perforation with or without extrusion through the urethrain the literature. These are summarized in table 1[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. …”

Spontaneous Extrusion of Ventriculoperitoneal Shunt Catheter through the Right Lumbar Region: A Case Report and Review of the Literature

“…The abdominal complications including pseudocyst formation, visceral perforation due to distal catheter migration through visceral organs such as the bowel, rectum, liver, bladder, scrotum and umbilicus are reported with the incidence rate of 25% [7,8,9,10]. Spontaneous extrusion of the peritoneal catheter through the intact skin is a rare complication.…”