Title:Anal Extrusion of Ventriculoperitoneal Shunt Distal Catheter: A Case Report and Literature Review
Volume: 21
Author(s): Jasmine Ahmed Alturaiki, Eissa Alousi, Mustafa Alhelal, Ali AlKhamees, Awn Alessa, Ibrahim Alahmed and Abdulsalam Mohammed Aleid*
Affiliation:
- Department of Neurosurgery, Medical College, King Faisal University, Al-Hofuf, Ahsa, Eastern Province, Saudi Arabia
Keywords:
Ventriculoperitoneal shunt (VPS), Anal extrusion, Bowel perforation, Hydrocephalus, Myelomeningocele (MMC), Shunt migration, Pediatric neurosurgery, External ventricular drain (EVD), Rare complications, Catheter-related infections.
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.
