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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 1  |  Page : 230-231

Extrusion of the Distal End of Ventriculoperitoneal Shunt through the Urethral Orifice in an Adult Male


Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, People's Republic of China

Date of Submission23-Apr-2016
Date of Decision26-Apr-2016
Date of Acceptance26-Apr-2016
Date of Web Publication24-Feb-2021

Correspondence Address:
Yuekang Zhang
37, Guo Xue Xiang, Wu Hou District, Chengdu
People's Republic of China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.310091

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How to cite this article:
Liang RF, Yang X, Liu Y, Zhang Y. Extrusion of the Distal End of Ventriculoperitoneal Shunt through the Urethral Orifice in an Adult Male. Neurol India 2021;69:230-1

How to cite this URL:
Liang RF, Yang X, Liu Y, Zhang Y. Extrusion of the Distal End of Ventriculoperitoneal Shunt through the Urethral Orifice in an Adult Male. Neurol India [serial online] 2021 [cited 2021 Apr 23];69:230-1. Available from: https://www.neurologyindia.com/text.asp?2021/69/1/230/310091




Sir/Madam,

A 29-year-old male presented with complaints of extrusion of the distal end of the ventriculoperitoneal (VP) shunt through his urethral orifice. He had a 19-year-old history of an operation for right-sided VP shunt for hydrocephalus as a result of a traffic accident. His VP shunt got blocked at the age of 24 years, for which the shunt system was removed and a novel right-sided VP shunt was placed. On clinical examination, the male was conscious and cooperative, with normal temperature. No meningeal signs or any peritoneal irritation signs were evident. The distal end of the VP shunt was protruded from the urethral orifice [Figure 1]a and blocked without drops of cerebrospinal fluid (CSF). A computed tomography (CT) scan of his brain showed hydrocephalus, and the ventricular catheter tip was in a correct position. An X-ray of his abdomen demonstrated an abnormal location of the distal end of the VP shunt [Figure 1]b. A CT scan of the lower abdomen showed the distal end of the VP shunt was protruded from the urethral orifice [Figure 1]c. After admission to our hospital, antibiotic treatment was prescribed. By exploring for cranial wound, the distal end of the VP shunt was pulled through the urethral orifice, and the ventricular catheter was not removed from the cranial wound after many tries. A new laparoscopically-assisted VP shunt was received and the distal end of the VP shunt was placed at the suprahepatic space [Figure 1]d.
Figure 1: (a) The extruded distal end of VP shunt. (b) X-ray of the patient shows an abnormal location of the distal end of VP shunt. (c) Abdominal CT shows the distal end of VP shunt protruding from urethral orifice. (d) Postoperative abdominal X-ray of patient shows that the distal end of VP shunt was placed at the suprahepatic space

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Migration of the distal catheter tip of a VP shunt through the urethral orifice is an extremely rare chronic complication of a VP shunt. This kind of complication has been more commonly observed and reported in childhood.[1],[2],[3] In the present case, we report for the first time, a chronic complication of VP shunt with urinary bladder perforation and extrusion through the urethral orifice in an adult male. To avoid this complication, the length of the distal end of VP shunt should be kept as short as possible in adults in clinical practice. This present case also suggests that the adequate follow-up time is as important for adult patients as it is for children.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pohlman GD, Wilcox DT, Hankinson TC. Erosive bladder perforation as a complication of ventriculoperitoneal shunt with extrusion from the urethral meatus: Case report and literature review. Pediatr Neurosurg 2011;47:223-6.  Back to cited text no. 1
    
2.
Mutlu M, Kader S, Aslan Y, Yazar U, Imamoglu M. An acute complication of ventriculoperitoneal shunt with bladder perforation and extrusion through the urethra in a newborn: Case report and review of the literature. Pediatr Neurosurg 2015;50:264-9.  Back to cited text no. 2
    
3.
Kataria R, Sinha VD, Chopra S, Gupta A, Vyas N. Urinary bladder perforation, intra-corporeal knotting, and per-urethral extrusion of ventriculoperitoneal shunt in a single patient: Case report and review of literature. Childs Nerv Syst 2013;29:693-7.  Back to cited text no. 3
    


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