A rare case of repeated migration and transurethral extrusion of ventriculoperitoneal shunt

Abstract

Bladder migration and transurethral extrusion is an extremely rare complication of ventriculoperitoneal (VP) shunt. Only eight cases have been reported in the English literature since 1995. We report a case of a 4-year-old boy with cerebral palsy, hydrocephalus, and VP shunted on both sides who presented with a protruded distal VP shunt from his urethral orifice. The patient was reported for having previous shunt extrusion through the anus. The patient was treated on by a multidisciplinary approach, involving a neurosurgeon and urologist. Shunt removal with simple procedure was smoothly achieved without morbidities. He was discharged home in satisfactory condition.

Rare case of migration and perforation of the urinary bladder by ventriculoperitoneal shunt catheter with intravesical knotted formation: A case report and literature review

“…[27,28] Migration and perforation of the distal end of the VPS in different regions of the body are relatively uncommon complications. [3,36,38] Migrations to the pleural cavity, pulmonary artery, breast, heart, navel, vagina, scrotum, bladder, intestine, oral, and anal protrusions have been reported. [2,[4][5][6][7]9,[12][13][14][15][16][17][18][19][20][21]23,25,[28][29][30][31][32][33][34][37][38][39][40][41][42][43] A case of migration of the distal end of the VPS catheter with intravesical knots formation, without body extrusion, or formation of calcification at the migration site is extremely rare, this being the first report found in the literature.…”

“…is case had a Table 1: Cases reported in the literature on bladder perforation through the distal end of the VPS. [3,[5][6][7][8][10][11][12]14,17,18,[22][23][24][26][27][28][29]31,33,36,37,[39][40][41][42] [22] 1 4 years/ female Increased Neurogenic bladder and myelodysplasia n.s. Extrusion of the distal part of the VPS through the urethra and repetitive UTIs Prasad et al [29] 1 6 years/ male Normal Hydrocephalus and cerebellar medulloblastoma 2 years Extrusion of the distal part of the VPS through the urethra Ueda et al [37] 1 82 years/ female Normal Hydrocephalus after subarachnoid hemorrhage 10 years Extrusion of the distal part of the VPS through the urethra and meningitis Yerkes et al [42] 2 n.s.…”

“…Extrusion of the distal part of the VPS through the urethra Barker et al [5] 3 [11] 2011 38 years Increased Hidden spina bifida n.s. Extrusion of the distal part of the VPS through an appendicovesicostomy (Mitrofanoff) Mihajlović et al [23] 2012 4 years/ female Normal Posthemorrhagic hydrocephalus 4 years Extrusion of the distal part of the VPS through the urethra Yazar et al [41] 2012 5 years/ female Normal Hydrocephalus after posterior fossa medulloblastoma surgery 4 years Meningitis, recurrent UTIs, and extrusion of the distal part of the VPS through the urethra Kataria et al [18] 2013 7 years/ male Normal Congenital hydrocephalus 5 years Extrusion of the distal part of the VPS through the urethra and intravesical knot Butler et al [7] 2013 [33] 2016 2 years/ male Normal Congenital hydrocephalus 1.5 years Dysuria, urinary incontinence, fever, headache, and extrusion of the distal part of the VPS through the urethra Miranda et al [24] 2016 4 months/ female Normal Congenital hydrocephalus 2 months Irritability, excessive crying, and extrusion of the distal part of the VPS through the urethra Xu et al [39] 2016 38 years/ male Normal Hydrocephalus 12 years Recurrent UTI's, hematuria and urinary incontinence Al Fauzi et al [3] 2017 4 years/ male Normal Congenital hydrocephalus and cerebral palsy 2 years Abdominal pain, extrusion of the distal part of the VPS through the urethra Rattan et al [31] 2017 n.s./male Normal Congenital hydrocephalus 10 months Extrusion of the distal part of the VPS through the urethra Yang et al [40] normal sized urinary bladder. e etiology of hydrocephalus was not associated with this complication.…”

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

“…In cases where transurethral exteriorization occurs the diagnosis is simple, for the rest, it is recommended to perform at least an imaging test such as ultrasound. Treatment is controversial given the low frequency of this pathology, but most authors choose to perform a laparotomy removing the complete device or external drainage [22][23][24][25]. Bladder catheterization for a minimum of 5 days and a broad-spectrum antimicrobial therapy is recommended.…”

A Review of Ventriculoperitoneal Shunt Migration

“…To date only 10 case reports of this occurrence have been reported as per a Pubmed review of the English literature [31,32,33,34,35,36,37]. Once within the bladder lumen the shunt tubing may present through the urethra [31,32,33,34,37], be associated with the development of a bladder calculus [38], or even rarer is a single case report of a ventriculo-peritoneal shunt tip perforating into the bladder lumen, knotting intra-luminally and subsequently presenting through the urethra [39].…”