Urethral Protrusion of the Distal End of Shunt.

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

Figure 2

X-ray of the abdomen showing shunt migration per urethra

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.[45] 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.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.