Unusual migration of distal ventriculoperitoneal shunt to Vagina via fallopian tube: A case report

Abstract

Introduction and Importance: Ventriculoperitoneal shunt (VPS) is the most common procedure performed on children with hydrocephalus. Migration of VPS outside the peritoneal cavity is rare, especially fallopian tube migration with vaginal extrusion without organ perforation. Presentation of Case: A 3-year-old girl came to the hospital with the main complaint of having a white tube exposed from her vagina 4 days before admission. A history of frequent clear watery discharge from the vagina since one week before the admission alongside intermittent pain in the suprapubic area was obtained from the parents. A laparotomy was conducted on the patient. We found the distal shunt catheter had adhered to the omentum and it appeared that the catheter tube entered the right fallopian tube before it went into the uterus and out to the vagina. We replaced the distal catheter with a new one. The patient came home on the fourth day of the post-surgery in a good condition. Clinical Discussion: The etiology of distal shunt catheter migration into the vagina remains unclear. Our patient is the third documented case of fallopian tube migration with vaginal extrusion without organ perforation, suspected due to postsurgical adhesions to the fallopian tube. An evaluation of vaginal discharge associated with abdominal pain is an important clue for distal migration of the VPS to the vagina. Conclusion: The migration of catheter to the vagina should be considered of profuse watery discharge from vagina alongside intermittent abdominal colicky pain. The surgical goal is to re-establish a new VP shunt system.

Keywords: Case report; Profuse watery vaginal discharge; Shunt migration; Ventriculoperitoneal shunt.

Fig. 1

White catheter (distal peritoneal shunt catheter) extruded through introitus vagina (red arrow), Foley catheter (black arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

A. Abdominal X-ray, distal peritoneal shunt catheter coiled at lower abdominal quadrant and go off the pelvic area/vagina, B. Head CT-scan revealed mild bilateral ventriculomegaly.

Fig. 3

A. Right infraumbilicus incision, showed catheter shunt adhesion to the right fallopian tube (white tube/black arrow), B. The shunt pump was effective, replacement of the distal shunt was performed through abdomen.