Anal Extrusion of Ventriculoperitoneal Shunt Distal Catheter: A Case Report and Literature Review.

Abstract

Background: The standard treatment for hydrocephalus is often the placement of a ventriculoperitoneal shunt (VPS), especially in patients with myelomeningocele (MMC). This case report aimed to enrich the existing knowledge by presenting a rare instance of asymptomatic anal extrusion of a VPS catheter in an infant, along with a review of the relevant literature.

Case presentation: A 2-month-old male infant with myelomeningocele (MMC) and hydrocephalus presented with asymptomatic anal extrusion of his ventriculoperitoneal shunt (VPS) catheter, discovered by his mother. Emergency imaging revealed distal catheter migration through the rectosigmoid junction. Surgical management included (1) laparoscopic-assisted catheter removal with bowel repair using Vicryl sutures, (2) intraoperative external ventricular drain (EVD) placement, and (3) 14-day antibiotic prophylaxis. Cerebrospinal fluid analysis remained normal throughout the treatment. Following three weeks of infection monitoring, contralateral VPS replacement was performed successfully, with postoperative imaging confirming optimal shunt function and resolved hydrocephalus. This case highlighted the importance of caregiver vigilance in identifying this rare but serious complication, even in asymptomatic patients (Fig. 1).

Conclusion: Although anal extrusion of a VPS catheter is an uncommon but serious complication, primarily seen in pediatric patients, it can lead to lifethreatening infections if untreated. Prompt surgical intervention along with broad-spectrum antibiotic therapy is critical. This report highlights the need for recognizing classic symptoms of intestinal perforation and catheter migration in pediatric patients.