Migration of the Distal Catheter of Ventriculoperitoneal Shunts in Pediatric Age Group: Case Series

Ventriculoperitoneal (VP) shunting is the most commonly performed procedure in the treatment of hydrocephalus. VP shunt migration can occur at different sites. The aim of the study was to present different sites of abnormal distal shunt location, pathophysiology, and the management in each situation. Between 2014 and 2017, all patients with hydrocephalus in the Department of Neurosurgery, Cairo University, were gathered prospectively. All pediatric patients below the age of 12 years with shunt migration of the distal end of the VP shunt were identified. Of 1092 patients operated on by the VP shunt between 2014 and 2017, 15 presented with shunt dysfunction because of distal shunt migration (6 anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, and 1 umbilical). Especially upper lumbar extrusion and paraspinal shunt location are extremely rare. All the 15 patients were treated successfully with VP shunts and prospectively followed until they presented with complications on different occasions. Peritoneal complications are among the most common causes of VP failure. We present a rare complication where the shunt migrates outside the peritoneal cavity elsewhere with ambiguous pathogenesis. Special considerations have to be appointed during the shunt revision surgeries of these cases. •The aim of the study was to present different sites of abnormal distal shunt migration and the management in each situation.•Shunt migration occurred in 1.4% in the present series of 1092 prospectively collected pediatric patients with hydrocephalus.•Six anal, 3 scrotal, 1 colon, 1 peroral, 1 upper lumbar extrusion, 1 paraspinal, 1 penile, 1 umbilical.•Especially upper lumbar extrusion and paraspinal shunt migration are extremely rare.•We recommend distal end insertion of the VP shunt using a minilaparotomy or laparoscopic surgery.