Extrusion of a Ventriculoperitoneal Shunt through the Urethra: A Case Report and Review of Literature

Abstract

Background: The insertion of a ventriculo-peritoneal shunt (VP-shunt) has been the mainstay of treatment of hydrocephalus. Migration of the distal catheter can result in both hollow and solid viscera perforation with resultant extrusion through natural orifices. Per-urethral extrusion is extremely rare with fewer than 20 cases reported in literature. Methods: We report a case of a 1 year 7 months old female child who had a VP-shunt placed for congenital hydrocephalus. Five months post-procedure, the mother noticed that the shunt tube was coming out of the urethra and brought the child to hospital for evaluation. The child was voiding normally despite the extruded VP shunt. Results: On examination, the child was conscious, afebrile with no signs of infection, meningeal irritation or neurological deficit. The anterior fontanelle that was yet to fuse was sunken, and the abdominal examination was normal. Shunt series confirmed the integrity of the shunt and showed the distal catheter traversing outside through the urethra. Laboratory workups including a complete blood count and CSF studies were normal. The peritoneal catheter was accessed through an abdominal incision, with the distal end extracted downward from the urethra and the proximal end extracted upward from a scalp incision. Prophylactic antibiotics were administered for 5 days. The post-operative course was uneventful. Following further evaluation, re-insertion of a new VP-shunt was deemed unnecessary. The child was discharged home for continued follow up through clinic. Conclusion: Per-urethral extrusion of the distal end of a VP-shunt is a rare complication and requires urgent surgical intervention. Care is individualized and may include shunt revision, antibiotics and management of any other ensuing complication.