Unusual extrusion of distal end of ventriculoperitoneal shunt: Case series with literature review

Abstract

Background: Ventriculoperitoneal shunting is most common treatment for hydrocephalus. Ventriculoperitoneal (VP) shunt has been associated with complications from cerebral ventricles to peritoneal cavity [1]. Complications of shunt extrusion from neck, chest wall, pleural cavity, rectum, penis, stomach, gall bladder, vagina, scrotum, colon and diaphragm are known. The aim of this study is to present unusual extrusion of distal end of VP shunt through various routes, their pathophysiology and management. Methods: All patients of hydrocephalus who presented to Department of Neurosurgery, SMS Medical College Jaipur, India between 2011 and 2018 were gathered prospectively and those with unusual extrusion of distal end of VP shunt were identified in all age groups. Results: Of 1528 cases of primary VP shunt cases (first insertion) for hydrocephalus, only 8 cases of unusual distal end extrusion of ventriculoperitoneal shunt through neck, chest wall, anus, sigmoid colon and penis were identified. All cases were managed accordingly and followed regularly. Conclusion: Distal end VP shunt complications are one of the common causes of shunt failure. Author presented rare cases of unusual distal end extrusion of VP shunt through various unusual routes with different pathogenesis. Diagnosis is often delayed till the patient develops shunt malfunction, meningitis or shunt extrusion through unusual routes. All these conditions should be aggressively managed to decrease the morbidity and mortality associated with these complications. These patients should be kept under regular follow up.

Keywords

• VP (ventriculoperitoneal) shunt
• Hydrocephalus
• Extrusion of VP shunt
• Shunt complications