Urethral protrusion of the abdominal catheter of ventriculoperitoneal shunt: Case report of extremely rare complication

Abstract

Hydrocephalus in its various forms constitutes one of the major problems in pediatric neurosurgical practice. The placement of a ventriculoperitoneal (VP) shunt is the most common form of treatment for hydrocephalus, so that all neurosurgeons struggle with shunt malfunctions and their complications. Well-known complications are connected with the use of the valve systems (malfunction, infectious, overdrainage, secondary craniosynostosis, etc.). We report an unusual case of protruding abdominal catheter from the urethra. This girl had received a VP shunt for hydrocephalus following surgery of posterior fossa medulloblastoma 4 years ago. After admission, the entire system was removed, antibiotic treatment was administered for 2 weeks, and a new VP shunt was placed. The postoperative course was uneventful. This complication is extremely rare.

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.…”

“…The most feared complication of a catheter extrusion is infection such as bacterial meningitis, intra-abdominal abscess or urinary tract infection [2,13,15,16,18,19]. Urinary tract infection [2,13,15,18,19], meningitis [16] and intra-abdominal abscess [13] have been reported to be associated with this complication in the literature.…”

“…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]. …”