Vaginal cerebrospinal fluid discharge due to fallopian tube perforation by distal catheter of ventriculoperitoneal shunt: a case report

Abstract

Background: Ventriculoperitoneal shunt (VPS) is the most commonly performed procedure in the treatment of hydrocephalus in children. Shunt migration outside the peritoneal cavity is quite rare. This study describes one case of clear migration to the Fallopian tube and cerebrospinal fluid (CSF) discharge from the vagina.

Case description: A five-year-old female patient with VPS was admitted to the hospital with a 40-day history of abdominal pain, vomiting, and fever. She was in Glasgow Coma Scale 15, and she presented CSF discharge from the vagina. Abdominal ultrasonography and tomography showed a heterogeneous cyst involving the distal tip of the catheter close to the Fallopian tube. The patient underwent laparotomy with the aid of pediatric surgeons, which confirmed that the end of the distal catheter was present inside the right Fallopian tube. The catheter was repositioned in the peritoneal cavity without intercurrences. CSF examination showed absence of infection and negative culture. The patient was discharged from the hospital cured without requiring antibiotics.

Conclusion: Abdominal complications involving the distal VPS catheter are frequently reported in the literature; distal catheter migration to the Fallopian tube with CSF discharge from the vagina, however, is a very rare presentation. Surgical repair, with a multidisciplinary team, to reposition the distal catheter in the peritoneal cavity was sufficient for adequate treatment of this patient.