Urethral Extrusion of a Peritoneal Catheter in a Patient with a Neobladder: A Rare Complication of Shunt Insertion

Abstract

The insertion of a ventriculoperitoneal shunt (VPS) is considered the standard of care for several forms of hydrocephalus. Abdominal complications are most common with this procedure, comprising up to 30% of all shunt-related problems. Conversely, visceral perforation or extrusion of the shunt apparatus is rare. Herein we report a rare complication of VPS insertion in which the peritoneal catheter was spontaneously extruded through the urethra of a patient with a neobladder. We further discuss the pathogenesis, diagnosis, and treatment of this condition.

Key words

hydrocephalus - extrusion - migration - perforation - urethra - ventriculoperitoneal shunt

• References

• 1 Ansari S, Nejat F, Dadmehr M. Extrusion of ventriculoperitoneal shunt catheter through the rectum and retrograde meningitis. Pediatr Infect Dis J 2005; 24: 1027
• 2 Berhouma M, Messerer M, Houissa S et al. Transoral protrusion of a peritoneal catheter: a rare complication of ventriculoperitoneal shunt. Pediatr Neurosurg 2008; 44: 169-171
• 3 Birbilis T, Zezos P, Liratzopoulos N et al. Spontaneous bowel perforation complicating ventriculoperitoneal shunt: a case report. Cases J 2009; 2: 8251
• 4 Borkar SA, Satyarthee GD, Khan RN et al. Spontaneous extrusion of migrated ventriculoperitoneal shunt catheter through chest wall: a case report. Turk Neurosurg 2008; 18: 95-98
• 5 de Aquino HB, Carelli EF, Borges Neto AG et al. Nonfunctional abdominal complications of the distal catheter on the treatment of hydrocephalus: an inflammatory hypothesis? Experience with six cases. Childs Nerv Syst 2006; 22: 1225-1230
• 6 Emejulu JK, Ugwu JO. Combating complications following ventriculoperitoneal shunting in a new centre. Pediatr Neurosurg 2009; 45: 446-450
• 7 Furness 3rd PD, Franzoni DF, Decter RM. Bladder augmentation: does it predispose to prosthetic infection of simultaneously placed artificial genitourinary sphincters or in situ ventriculoperitoneal shunts?. BJU Int 1999; 84: 25-29
• 8 Ghritlaharey RK, Budhwani KS, Shrivastava DK et al. Trans-anal protrusion of ventriculo-peritoneal shunt catheter with silent bowel perforation: report of ten cases in children. Pediatr Surg Int 2007; 23: 575-580
• 9 Kanojia R, Sinha SK, Rawat J et al. Unusual ventriculoperitoneal shunt extrusion: experience with 5 cases and review of the literature. Pediatr Neurosurg 2008; 44: 49-51
• 10 Li G, Dutta S. Perioperative management of ventriculoperitoneal shunts during abdominal surgery. Surg Neurol. 2008; 70: 492-495 ;discussion 495–497
• 11 Mortellaro VE, Chen MK, Pincus D et al. Infectious risk to ventriculo-peritoneal shunts from gastrointestinal surgery in the pediatric population. J Pediatr Surg. 2009; 44: 1201-1204 ;discussion 1204–1205
• 12 Mwachaka PM, Obonyo NG, Mutiso BK et al. Ventriculoperitoneal shunt complications: a three-year retrospective study in a Kenyan national teaching and referral hospital. Pediatr Neurosurg 2010; 46: 1-5
• 13 Neto AR, Bezerra MJ, Farias MC et al. Unusual extrusion of ventriculoperitoneal shunt. Acta Neurochir (Wien) 2011; 153: 203-204
• 14 Popa F, Grigorean VT, Onose G et al. Laparoscopic treatment of abdominal complications following ventriculoperitoneal shunt. J Med Life 2009; 2: 426-436
• 15 Prasad VS, Krishna AM, Gupta PK. Extrusion of peritoneal catheter of ventriculoperitoneal shunt through the urethra. Br J Neurosurg 1995; 9: 209-210
• 16 Vinchon M, Baroncini M, Laurent T et al. Bowel perforation caused by peritoneal shunt catheters: diagnosis and treatment. Neurosurgery 2006; 58: ONS76-ONS82
• 17 Yerkes EB, Rink RC, Cain MP et al. Shunt infection and malfunction after augmentation cystoplasty. J Urol 2001; 165 (6 Pt 2) 2262-2264