Vaginal extrusion of a ventriculo-peritoneal shunt catheter in an adult

Abstract

Ventriculo-peritoneal shunts (VPS) are commonly used in the treatment of various neurosurgical conditions, including hydrocephalus and pseudotumor cerebri. We report only the second case of vaginal extrusion of a VPS catheter in an adult, and the first case with a modern VPS silastic peritoneal catheter. A 45-year-old female with a history of VPS for pseudotumor cerebri, Behcet's syndrome, and hysterectomy presented to our institution with the chief complaint of tubing protruding from her vagina after urination. On gynecologic examination, the patient was found to have approximately 15 cm of VPS catheter protruding from her vaginal apex. A computed tomography scan of the abdomen and shunt X-ray series demonstrated no breaks in the tubing, but also confirmed the finding of the VPS catheter extruding through the vaginal cuff into the vagina. The patient had the VPS removed and an external ventricular drain was placed for temporary cerebrospinal fluid diversion. Ventricular catheter cultures were positive for diphtheroids. After an appropriate course of antibiotics, a contralateral ventriculo-pleural shunt was placed one week later. Although vary rare, vaginal extrusion can occur in adults, even with modern VPS catheters.

Management of trans-vaginal extrusion of the distal ventriculoperitoneal shunt catheter: a systematic literature review from 1973 to 2021

“…A total 20 cases on the management of the above-mentioned complication were retrieved. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A case was excluded from the review, due to the incomplete desired details. 31 A total of 19 cases were recruited for the systematic review and retrieved from the 18 manuscripts.…”

“…9-12 Extrusion of the distal VPS catheter through the vaginal orifice has also been reported but less frequent, and twenty such cases have been reported to date. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A systematic literature review was performed for 19 such cases to highlight demographics, clinical characteristics, surgical interventions executed, complications, and the outcome. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]…”

“…[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] A systematic literature review was performed for 19 such cases to highlight demographics, clinical characteristics, surgical interventions executed, complications, and the outcome. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30]…”

Abnormal migration and extrusion of abdominal end of ventriculoperitoneal shunt: An experience of eight cases

“…[ 2 ] Transvaginal protrusion of a VP shunt catheter is exceedingly unusual, and has been reported very few times in literature. [ 3 ] This paper reports eight patients with extrusion and abnormal migration of the distal end of the VP shunt. The presenting features and management are highlighted.…”

A rare cause of vaginal foreign body: Ventriculoperitoneal shunt migration

“…However, transvaginal migration of VP shunt is extremely rare. [3] Abdominal surgical interventions increase the risk of such complications. As our patient had a shunt revision when she was 4 months old, and she had received a colostomy due to anal atresia during the newborn period, she had an increased risk for peritoneal complications.…”