Transoral extrusion of ventriculoperitoneal shunt distal segment: A case report of very rare complication

Background

Ventriculoperitoneal shunts (VPS) are a widely utilized neurosurgical intervention for managing hydrocephalus of diverse etiologies. While generally a safe and well-established treatment approach, VPS procedures are not without potential complications. The most frequently reported issues include infection, obstruction, disconnection or fracture of the shunt hardware, as well as skin erosion and overdrainage and tip migration. Migration of VPS tip through various body cavities and openings is a rare but serious complication. Transoral extrusion of the distal segment of a VPS is an exceedingly uncommon complication with only 43 case reports in the literature.

Observation

We report a case of 2-year-old male pediatric patient presented with the extrusion of VPS distal tip through the oral cavity. The patient underwent thorough investigation including shunt series. The patient was optimized and empiric broad-spectrum antibiotic administration and was subsequently taken to the operating room for shunt revision. The patient had favorable surgical outcome.

Conclusion

Transoral migration of the distal VPS component is an uncommon yet serious complication following VPS placement. This complication is primarily observed in pediatric patients within the first year after the initial VPS procedure. Most instances can be addressed by removing the distal segment, either through the oral cavity or the abdomen. Subsequent management involves monitoring the patient for signs of peritonitis, central nervous system infection, and progression of the underlying hydrocephalus. Prompt antibiotic treatment is required for any identified infections, and the hydrocephalus is managed by either inserting a new VPS or replacing only the distal segment.