Systematic Literature Review of the Management of Transanal Extrusion of Distal Ventriculoperitoneal Shunt Catheter

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.

Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion: A systematic literature review and meta-analysis

“…The probable reason for a greater number of intra-gastric migrations clinically presented as trans-oral extrusion of the distal VPS catheter in children than in adult/older population may be because the number of VPS placements carried out in infants and children are many folds more than done in adults and older age. Like the present findings, a recent review included n = 210 cases of the management of extrusion of the distal part of peritoneal catheter through the anal canal, also evidenced that in 73% of the cases, the age of the cases was ≤ 5 years of age[ 11 ]. For n = 19 of the Group A and n = 9 of the Group B cases, the details of the shunt type/which type of the VPS catheter implanted during the initial procedure was not available/not mentioned by the authors in the manuscripts[ 20 , 21 , 23 - 27 , 29 - 32 , 34 , 36 , 38 , 42 , 43 , 45 , 47 , 48 , 52 , 54 , 55 , 57 - 62 ].…”

“…Perforation of the gastrointestinal tract, urinary bladder, and uterus by the distal VPS catheter is a known complication of the VPS placement carried out for the treatment of hydrocephalus, and most of them clinically present with the extrusion of the peritoneal part of a VPS catheter through the natural orifices[ 10 - 14 ]. Perforation of the large bowel by the peritoneal end of a VPS catheter and extrusion of the same via the anal canal is most common and is reported to occur in 0.1% to 2.5% of the cases[ 10 , 11 ]. Migration of the distal VPS catheter into the stomach is a rare clinical entity, and two-thirds of them presented with the trans-oral extrusion of the distal part of peritoneal catheter[ 17 - 62 ].…”

“…In n = 5 of Group B cases, the interval from VPS insertion to the detection of the said VPS complication was 3 to 10 years. A recent systematic review (2022) of the n = 210 cases on the management of trans-anal extrusion of the distal VPS catheter also revealed that in 70% of the cases, it occurred within 12 mo after the VPS insertions[ 11 ]. Like the above finding, the present review also revealed that 60% of the entire cases and four-fifths of Group A cases were also diagnosed within 12 mo of the VPS insertion.…”

“…The occurrence of peritonitis after the bowel/colon perforation by a distal VPS catheter is not a rule, and it was not reported in most cases. In a systematic review of trans-anal extrusion of the distal VPS catheter, peritonitis was documented only in 3.8% of the cases[ 11 ]. Possibly for similar reasons like colon perforation clinically presented with per-rectal extrusion of VPS catheter, there was no peritonitis even though there was perforation and migration of distal VPS into the stomach in a present review.…”

“…Perforation of the hollow viscus viz gastrointestinal tract, urinary bladder, and uterus (female genital tract) by the peritoneal end of a VPS catheter is known, and it may occur with or without extrusion of the distal VPS catheter through the natural orifices[ 10 - 14 ]. Perforation of the large bowel by the peritoneal end of a VPS catheter and protrusion/extrusion of the same via the anal canal is commonly reported[ 10 , 11 ]. Migration of the distal VPS catheter into the stomach is a rare clinical entity[ 14 ].…”