Perforation of the bladder by a peritoneal catheter: an unusual late complication of ventriculo-peritoneal shunt

Late perforation of the bladder by an abdominal catheter of a ventriculoperitoneal (VP) shunt is extremely rare. We report the successful treatment of a patient who presented with this complication. An 82-year-old woman received a V-P shunt for normal pressure hydrocephalus following subarachnoid hemorrhage. Ten years later she was admitted to our hospital with neck pain. A few days after admission, the tip of the peritoneal catheter was found to be protruding from the urethra during urination. Subsequently, the patient developed meningitis. Contrast study of the distal tubing demonstrated the continuity of the peritoneal shunt tube. After the entire system was removed, antibiotic treatment was administered for 2 weeks, and a new VP shunt was placed on the opposite side. The post-operative course was uneventful. Previous reports regarding complications after the placement of a VP-shunt show that periodic chest and abdominal X-ray studies are important. In this case, however, the peritoneal tube was not able to be observed on abdominal plain film. For this reason, an unfaded radiopaque tube is necessary if there is to be early diagnosis of late organic perforation by a peritoneal shunt tube.