What is new in the management of distal VP shunt catheter extrusion through the anus: A brief review of recently published literature

Abstract

The objectives of the current study were to briefly review the demographics, clinical characteristics, and outcomes of the surgical procedures performed for the cases managed for the trans-anal extrusion of the distal ventriculo-peritoneal (VP) shunt catheter. The current literature review focused on cases published between January 1, 2021, to December 31, 2024.
The relevant literature/articles were retrieved through an online database search. This literature review included n=50 cases (males n=27 and females n=23) of distal VP shunt catheter extrusion through the anus. In approximately four-fifths (n=40) of cases, the indication for primary VP shunt insertion was congenital hydrocephalus. Approximately two-thirds (n=31) of cases involved were ≤ 24 months at the extrusion of the distal VP shunt catheter. Approximately two-thirds (n=32) of extrusions of distal VP shunt catheter occurred within 12 months of the initial VP shunt catheter insertion or last shunt revision. The main complaint reported was the extrusion of the distal shunt catheter through the anal canal. For 96% (n=48) of the cases, the entire shunt system or the distal shunt catheters were removed with or without external ventricular drainage (EVD). Most cases recovered well, but this review also noted one death. Distal ventriculo-peritoneal shunt catheter extrusion through the anus, primarily reported in children ≤ 5 years, though cases have also been reported in older children, adults, and older individuals. For management, the preferred approach was the removal of the entire or distal shunt catheter with or without external ventricular drainage and delayed re-VP shunt catheter insertion.