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

Why the migration of peritoneal shunt catheter into the scrotum occurs more in children: A systematic literature review

BACKGROUND

Ventriculoperitoneal shunt (VPS) catheter insertion is one of the most widely accepted surgical procedures for hydrocephalus. Migration of the end of the distal VPS catheter into the scrotum is one of the rare complications of VPS catheter insertion.

AIM

To review the demographics, clinical characteristics, and outcomes of the surgical procedures provided for the cases of migration of the distal VPS catheter into the scrotum.

METHODS

This is a systematic review of the published cases, and the literature search was performed from 1974 to June 30, 2024, to retrieve the relevant manuscripts. The cases were grouped into two. Group A included cases of migration of the distal VPS catheter into the scrotum, detected in children. Group B included the cases of migration of the distal VPS catheter into the scrotum, which was detected in adults and older people.

RESULTS

One hundred-twenty cases of migration of the distal end of VPS catheter into the scrotum were included in this study, a systematic literature review. Group A included n = 112 cases, and group B included n = 8 cases only. Three-fourths of the cases involved the right scrotum. Bilateral involvement was rare. The indication for initial VPS insertion was congenital hydrocephalus in four-fifths of the group A cases. The majority were infants at the time of initial shunt insertion. Four-fifths of the group A cases were 24 months-old or younger at the time of clinical diagnosis and treatment was provided for migration of the distal VPS catheter into the scrotum. In children, the interval from VPS insertion or shunt revision if any, to the diagnosis of the complication mentioned above was 12 months or less in four-fifths of the cases. The repositioning of migrated distal VPS catheter into the peritoneal cavity and herniotomy was preferred for the surgical procedure, and it was performed for two-thirds of group A cases.

CONCLUSION

Migration of the distal part of the VPS catheter into the scrotum is a rare complication of cerebrospinal fluid diversion via VPS catheter insertion. It was most frequent in children, and the right side of the scrotum was most often involved.

Trans-Oral Protrusion of the Distal End of a Ventriculoperitoneal Shunt: A Case Report of an Unusual Complication

Ventriculoperitoneal shunting (VPS) is the surgical technique of choice to manage pediatric hydrocephalus. Despite having good results, it is prone to complications, some of which are rare. This is the case report of a 2-year-old male, with an uncomplicated VPS done at 6 months of age, presenting with vomiting, irritability, anorexia, and drooling. There was an oral protrusion of a tube dripping clear fluid. Imaging studies demonstrated evidence of gastric perforation with a cephalic migration and transoral protrusion of the distal end of the shunt tubing. A gastroplasty, and immediate revision of the distal shunt were done free of any complications. This case report underlines the importance of recognizing and managing trans-oral protrusion of the distal end of VPS system in a timely manner, and raises awareness of this uncommon complication and its potential influence on patient health and survival, given ventriculitis' high lethality.