Vesical calculi formation on the slit valves of a migrated distal end of ventriculoperitoneal shunt

Abstract

Various complications of distal end of the ventriculoperitoneal (VP) shunt have been described in the literature. We present, here, an extremely rare and potentially severe complication of vesical calculi formation on the slit valves of distal end of VP shunt which erosively migrated into the urinary bladder. Suprapubic cystolithotomy performed, peritoneal end of the tube found to be eroding and entering into the bladder with two calculi firmly stuck to slit valves in the distal end of the tubing were removed. Shunt was functional, therefore, it was pulled out and repositioned on the superior aspect of the liver; the urinary bladder was repaired. Patient did well postoperatively. This complication was revealed 1.5 years after the shunt was implanted. Although there were symptoms of dysuria and dribbling of urine of short duration, the patient did not show obvious peritoneal signs; suggesting that, penetration of a VP shunt into the urinary bladder can remain asymptomatic for a long period of time, disclosed late and can lead to considerable morbidity. Careful follow-up is important and management should be individualized.

Migration of the distal catheter of the ventriculoperitoneal shunt in hydrocephalus

“…Fibrous adhesion entails the formation of a fibrous tract that anchors the catheter tip to the viscus serosa. Additional risk factors that could contribute to visceral penetration include previous surgery in the affected organ and increased intra‐abdominal pressure (Gupta et al, ).…”

“…The scarcity and late onset of pelvic migration could be attributed to the relative toughness of pelvic organs such as the urinary bladder, which is very difficult to penetrate (Xu et al, ). Penetration of a VPS catheter into the urinary bladder or the uterine tube can remain asymptomatic for a long time but can cause abdominal pain, vomiting, and dysuria; in the long term it can also induce the formation of vesical calculi (Butler et al, ; Gupta et al, ; Xu et al, ).…”

Scrotal migration of two ventriculoperitoneal shunts presenting as hydrocele

“…Ventriculoperitoneal (VP) shunt is a common procedure performed for treating hydrocephalus. [ 1 ] There is a higher rate of inguinal hernia and hydrocele in pediatric patients who undergo VP shunt procedure. [ 2 3 ] Migration of peritoneal end of the VP shunt into the scrotum is uncommon.…”

“…Introduced in 1908, VP shunt is one of the most common neurosurgical procedures performed for patients with hydrocephalus. [ 1 ] VP shunt complications include shunt infection, over drainage, and shunt malfunction. Peritoneal complications involve pseudocyst formation, intestinal obstruction or volvulus, perforations of a hollow viscus, and protrusion outside the body; other shunt complications are disconnection and migration.…”

“…Peritoneal complications involve pseudocyst formation, intestinal obstruction or volvulus, perforations of a hollow viscus, and protrusion outside the body; other shunt complications are disconnection and migration. [ 1 ] There is a higher rate of inguinal hernia and hydrocele in pediatric patients who undergo a VP shunt procedure. [ 2 3 ] The reported incidence of inguinoscrotal complications may be as high as 10%–20%.…”