Laparoscopic repair of transurethral extrusion of a ventriculoperitoneal shunt: A case report

Abstract

Introduction

Transurethral protrusion of ventriculoperitoneal shunt is a rare finding with few reported cases in the literature. As most presentations are treated with an open surgical approach, our case details successful management with laparoscopic intervention. Here we describe the presentation, diagnosis, and management of a pediatric patient with erosion and extrusion of a ventriculoperitoneal shunt through the urethra.

Case presentation

A 3-year-old girl with a history of congenital hydrocephalus treated with ventriculoperitoneal shunt presented to the Emergency Department after an incidental finding of the peritoneal end of the shunt protruding from the urethra draining cerebrospinal fluid (CSF). The patient was asymptomatic with vitals and laboratory values within normal limits. Urine and CSF cultures were negative. Preoperative x-ray showed distal midline protrusion of the shunt. Due to exposed hardware with risk of infection, a combined surgical effort between pediatric urology, neurosurgery, and general surgery was implemented. Laparoscopy was utilized to transect the shunt tubing with subsequent removal through the urethra, revealing a posterior cystotomy. The bladder defect was closed entirely with absorbable suture. The shunt hardware was removed in its entirety and an extraventricular drain (EVD) was placed. The patient subsequently underwent an endoscopic third ventriculostomy (ETV) and did not require shunt replacement. The postoperative course was uneventful with benign follow up imaging.

Conclusion

Minimally invasive surgical intervention can be utilized as a safe and effective alternative to open surgery for treatment of ventriculoperitoneal shunt migration. As cases may present asymptomatically, a high index of suspicion with detailed physical exam should be applied.