Urinary Bladder Perforation by Ventriculoperitoneal Shunt Manifested as Spontaneous Per-Urethral Extrusion of Shunt Catheter

Abstract

Various complications of distal end of ventriculoperitoneal shunt (VPS) have been described in the literature, but bladder perforation by VPS is considered extremely rare. We report a case of 35-year-old man who had underlying recurrent 4th ventricle ependymoma and hydrocephalus. Five months prior to current presentation, he had VPS revision for dislodged peritoneal catheter. Intraoperatively the dislodged catheter had to be left in situ as it had completely gone intraperitoneally. He was apparently asymptomatic until he presented with spontaneous passage of VPS catheter per-urethra without signs of peritonitis or central nervous system (CNS) infection. Computed tomography (CT) revealed intact new VPS and no contrast extravasation from bladder. We postulated that the dislodged peritoneal catheter might have eroded into the bladder for a considerable period of time and the perforation had already spontaneously sealed. He was managed conservatively with an indwelling urinary catheter for a week and given prophylactic antibiotics against CNS infection. Since dislodged pieces of shunt tubing in the peritoneal cavity are generally believed to be asymptomatic, it is a common practice to leave them particularly if they are deeply embedded in surrounding tissues. Nevertheless, clinician must be mindful that such practice may potentially lead to serious complications as exemplified in our case.