Medical Journal of Dr. D.Y. Patil Vidyapeeth (Jan 2022)
Systematic literature review of the management of transanal extrusion of distal ventriculoperitoneal shunt catheter: 1966–2020
Abstract
Perforation of the colon with or without transanal extrusion of the distal ventriculoperitoneal shunt (VPS) catheter is a well-known but a serious complication after VPS insertion done for the treatment of hydrocephalus. The objectives were to review the demographics, clinical characteristics, operative procedures performed, postoperative complications, and the final outcome of the published cases, relating to the transanal extrusion of the distal VPS shunt catheter. Electronic database search was performed to retrieve the published/available literature relating to the transanal extrusion of VPS catheter. The manuscripts relating to the above-mentioned complication were retrieved from 1966 to December 2020. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines are followed for this review. This review included 210 cases comprising 142 (67.6%) males and 68 (32.3%) females. In two-third (n = 141) of the cases, the indication for the initial VPS insertion was the congenital hydrocephalus. In 60% of the cases, the initial VPS insertion was done during infancy. In 70% of the cases, the interval from VPS insertion to the diagnosis of transanal extrusion of the distal VPS catheter was within 12 months. Transanal extrusion of the distal VPS catheter was the chief complaint. In two-third of the cases, it was asymptomatic transanal extrusion of distal VPS catheter. In remaining one-third of the cases, it was symptomatic transanal extrusion of the distal VPS catheter, and they had either symptoms relating to the central nervous system or gastrointestinal tract. Three-fourth of the cases were managed by the removal of the entire or the distal VPS catheter with or without external ventricular drainage (EVD). Fifty percent of the above-mentioned complication was managed by doing percutaneous surgical procedures, and another one-third of them were managed by doing laparotomy. Complications were also evident in 16 (7.6%) of the cases during the postoperative period. This review revealed only 6 (2.8%) deaths. Transanal extrusion of the distal VPS catheter occurred across all the age groups. Eighty percent of the complications occurred in children below the age of 10 years. Three-fourth of the cases were managed by the removal of the entire or distal VPS catheter with or without EVD. In three-fourth of the cases, repair of the perforated bowel/colon was not done and that healed spontaneously after the removal of the extruded VPS catheter.
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