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LETTER TO EDITOR
Year : 2018  |  Volume : 13  |  Issue : 3  |  Page : 371-372
 

Urethral protrusion of the distal end of shunt


Assistant Professor, Department of Neurosurgery, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Web Publication7-Sep-2018

Correspondence Address:
Dr. Shailendra D Anjankar
S.D. Hospital, Plot no. 50, Ganesh Nagar, Great Nag Road, Nagpur, Maharashtra 440024
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JPN.JPN_54_18

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How to cite this article:
Anjankar SD. Urethral protrusion of the distal end of shunt. J Pediatr Neurosci 2018;13:371-2

How to cite this URL:
Anjankar SD. Urethral protrusion of the distal end of shunt. J Pediatr Neurosci [serial online] 2018 [cited 2018 Dec 11];13:371-2. Available from: http://www.pediatricneurosciences.com/text.asp?2018/13/3/371/240787




Sir,

Eight-year-old male child from rural India presented with history of protrusion of white tube-like structure from urethra. He was a known case of meningitis with shunt failure, operated at outside private hospital for shunt surgery thrice. On examination, he was drowsy, occasionally following commands, pupils bilaterally reacting, no sunset signs, AF fused, head circumference 90th percentile for the age, no visible veins, no signs of meningeal irritation, afebrile, and vitals stable. He could also pass urine, but there was pain at urethra while micturition. Shunt tube could be visualized protruding out through urethra [Figure 1]. His X-ray of the abdomen showed that shunt distal end was migrated and was protruding through urethra [Figure 2]. He was started on antibiotics and was planned for surgery. But the relatives were not willing for it.
Figure 1: Distal end of shunt visible through urethra

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,
Figure 2: X-ray of the abdomen showing shunt migration per urethra

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The number of ventriculoperitoneal (VP) shunts has risen in many centers across the country. Despite, increasing popularity and success of endoscopic third ventriculostomy, VP shunt is still considered as the gold standard of treatment.[1] The most common distal VP shunt complications such as shunt infection, subcutaneous collection of cerebrospinal fluid, bowel perforation, catheter disconnection, and migration of the catheter and protrusion through the mouth, umbilicus, bladder, vagina, anus, and scrotum are reported.[2] About 21 cases of urethral protrusion are reported till date.[3] There are many hypotheses given for perforations of viscera, such as poor general condition of the patient with weakening of the viscera wall, and constant pressure of the abutting tip along with local inflammatory reaction, leading to erosion of the visceral wall and entrance of tip in the lumen.[4],[5] Though the complications cannot be predicted, temporary urinary catheter placement or tapping over bladder to empty it before surgery can be performed to avoid such complications. And improving the nutrition of the patient before and after the surgery is crucial in Indian scenario.

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.

Acknowledgement

The author acknowledges the support from Jawaharlal Nehru Medical College, Sawangi and Acharya Vinoba Bhave Rural Hospital for this work.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Venkataramana NK. Hydrocephalus Indian scenario: a review. J Pediatr Neurosci 2011;13:S11-22.  Back to cited text no. 1
    
2.
Yazar U, Kanat A, Akca N, Gazioglu G, Arda IS, Kazdal H. Urethral protrusion of the abdominal catheter of ventriculoperitoneal shunt: case report of extremely rare complication. J Pediatr Neurosci 2012;13:111-3.  Back to cited text no. 2
    
3.
Rattan KN, Hooda R, Khursheed A, Gupta S. Extrusion of peritoneal end of ventriculoperitoneal shunt through urethra in an infant: a rare complication. Pediatr Urol Case Rep 2017;13:395-8.  Back to cited text no. 3
    
4.
Akyüz M, Uçar T, Göksu E. A thoracic complication of ventriculoperitoneal shunt: symptomatic hydrothorax from intrathoracic migration of a ventriculoperitoneal shunt catheter. Br J Neurosurg 2004;13:171-3.  Back to cited text no. 4
    
5.
Sarkari A, Borkar SA, Mahapatra AK. Anal extrusion of migrated ventriculo-peritoneal shunt catheter: an unusual complication and review of literature. Asian J Neurosurg 2016;13:459.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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